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ICD-10 Guide
ICD-10 CodesE10.3411

E10.3411

Billable

Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema (right eye)

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

Code Description

ICD-10 E10.3411 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema (right eye).

Key Diagnostic Point:

E10.3411 refers to a specific complication of Type 1 diabetes mellitus characterized by severe nonproliferative diabetic retinopathy (NPDR) with macular edema in the right eye. Type 1 diabetes is an autoimmune condition where the pancreas produces little to no insulin, leading to elevated blood glucose levels. Over time, chronic hyperglycemia can cause damage to the retinal blood vessels, resulting in NPDR, which is marked by retinal hemorrhages, exudates, and microaneurysms. The presence of macular edema indicates fluid accumulation in the macula, the central part of the retina responsible for sharp vision, which can lead to significant visual impairment. Management of this condition often involves strict glycemic control, regular ophthalmologic evaluations, and may include treatments such as laser therapy or intravitreal injections to reduce edema and prevent further vision loss. The severity of the retinopathy and the presence of macular edema necessitate careful monitoring and intervention to preserve vision and manage diabetes effectively.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition requires detailed documentation.
  • Differentiation between types of diabetic retinopathy is crucial.
  • Management plans may vary significantly based on severity.
  • Need for regular updates on patient’s HbA1c levels and treatment response.

Audit Risk Factors

  • Inadequate documentation of retinopathy severity.
  • Failure to document HbA1c levels and treatment plans.
  • Lack of follow-up notes regarding eye examinations.
  • Misclassification of the eye affected (right vs. left).

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes, requiring insulin adjustments or new treatment plans.

Billing Considerations

Endocrinologists must document the patient's overall diabetes management and any referrals to ophthalmology.

Ophthalmology

Documentation Requirements

Detailed findings from eye examinations, including retinal imaging and assessments of macular edema.

Common Clinical Scenarios

Patients with visual complaints related to diabetic retinopathy requiring intervention.

Billing Considerations

Ophthalmologists should ensure clarity in documenting the severity of retinopathy and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use E10.3411 When
  • According to ICD
  • 10 coding guidelines, E10
  • 3411 should be used when there is a confirmed diagnosis of Type 1 diabetes with severe NPDR and macular edema in the right eye
  • Coders must ensure that documentation supports the diagnosis and that the condition is actively managed

Exclusion Criteria

Do NOT use E10.3411 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Intravitreal injection of a pharmacologic agent

Clinical Scenario

Used for treating macular edema in patients with diabetic retinopathy.

Documentation Requirements

Document indication for injection, patient consent, and follow-up plans.

Specialty Considerations

Ophthalmologists must ensure proper coding based on the specific treatment provided.

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 chronic conditions like diabetic retinopathy.

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 chronic conditions like diabetic retinopathy.

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 chronic conditions like diabetic retinopathy.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3411?

Coding E10.3411 accurately reflects the severity of diabetic retinopathy and ensures appropriate management and treatment plans are in place for patients with Type 1 diabetes.