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ICD-10 Guide
ICD-10 CodesE10.341

E10.341

Billable

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E10.341 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema.

Key Diagnostic Point:

E10.341 refers to a specific complication of Type 1 diabetes mellitus characterized by severe nonproliferative diabetic retinopathy (NPDR) accompanied by macular edema. In this condition, the retinal blood vessels become damaged due to prolonged hyperglycemia, leading to leakage of fluid into the macula, which is critical for central vision. Patients may experience blurred vision, difficulty reading, and other visual disturbances. The severity of NPDR is determined by the extent of retinal changes, including microaneurysms, retinal hemorrhages, and exudates. Macular edema is a significant cause of vision loss in diabetic patients and requires careful monitoring and management. Treatment options may include laser therapy, intravitreal injections, and strict glycemic control to manage blood sugar levels effectively. Regular eye examinations are essential for early detection and intervention to prevent further complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise documentation of diabetes type and complications
  • Differentiation between types of diabetic retinopathy
  • Need for detailed clinical information regarding visual acuity and treatment
  • Potential for multiple co-existing conditions

Audit Risk Factors

  • Inadequate documentation of visual acuity and treatment plans
  • Failure to specify the type of diabetes and its complications
  • Misclassification of the severity of retinopathy
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, visual acuity measurements, and treatment plans.

Common Clinical Scenarios

Patients presenting with blurred vision or sudden vision loss due to diabetic retinopathy.

Billing Considerations

Ensure that all findings are documented clearly to support the diagnosis and treatment provided.

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including HbA1c levels and insulin regimen.

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the patient's overall diabetes management plan and any referrals made.

Coding Guidelines

Inclusion Criteria

Use E10.341 When
  • According to ICD
  • 10 guidelines, E10
  • 341 should be used when there is clear documentation of Type 1 diabetes with severe NPDR and macular edema
  • It is essential to ensure that the documentation supports the severity and specific complications of the condition

Exclusion Criteria

Do NOT use E10.341 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Laser photocoagulation

Clinical Scenario

Used for treatment of diabetic retinopathy.

Documentation Requirements

Document the indication for laser treatment and the extent of retinopathy.

Specialty Considerations

Ophthalmologists should ensure that all treatment plans are well-documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetic conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetic conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and facilitating better management of diabetic conditions.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of macular edema in diabetic retinopathy?

Macular edema is a critical complication of diabetic retinopathy that can lead to significant vision loss. It occurs when fluid leaks into the macula, affecting central vision. Early detection and treatment are essential to prevent irreversible damage.