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ICD-10 Guide
ICD-10 CodesE10.35

E10.35

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy

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

Code Description

ICD-10 E10.35 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy.

Key Diagnostic Point:

E10.35 refers to Type 1 diabetes mellitus characterized by the presence of proliferative diabetic retinopathy (PDR), a severe complication of diabetes that affects the retina. PDR occurs when new, abnormal blood vessels grow on the surface of the retina, which can lead to vision loss and blindness. This condition is typically a result of chronic hyperglycemia, which damages the retinal blood vessels over time. Patients with Type 1 diabetes often require insulin therapy to manage their blood glucose levels effectively. The management of diabetes includes regular monitoring of HbA1c levels, which should ideally be maintained below 7% to reduce the risk of complications such as PDR. The presence of PDR indicates a significant progression of diabetic eye disease, necessitating close monitoring and potential interventions such as laser therapy or vitrectomy. Accurate coding of E10.35 is crucial for appropriate treatment planning and reimbursement, as it reflects the severity of the patient's condition and the need for specialized care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Need for precise documentation of retinopathy severity
  • Differentiation from non-proliferative diabetic retinopathy
  • Management of insulin therapy and HbA1c levels

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of evidence for insulin management plans
  • Misclassification of diabetic retinopathy type

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including the presence and extent of proliferative changes.

Common Clinical Scenarios

Patients presenting with vision changes or diabetic eye disease requiring intervention.

Billing Considerations

Ensure documentation reflects the severity of retinopathy and any treatments provided.

Endocrinology

Documentation Requirements

Comprehensive diabetes management plans, including insulin regimens and HbA1c monitoring.

Common Clinical Scenarios

Patients with poorly controlled diabetes and complications requiring insulin adjustments.

Billing Considerations

Document all aspects of diabetes management to support coding and reimbursement.

Coding Guidelines

Inclusion Criteria

Use E10.35 When
  • According to ICD
  • 10 coding guidelines, E10
  • 35 should be used when the patient has Type 1 diabetes with documented proliferative diabetic retinopathy
  • It is essential to ensure that the documentation supports the diagnosis and that any related complications are also coded appropriately

Exclusion Criteria

Do NOT use E10.35 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for patients with proliferative diabetic retinopathy requiring intervention.

Documentation Requirements

Document the indication for the procedure and any pre-operative assessments.

Specialty Considerations

Ophthalmology should ensure that all findings are documented to support the procedure.

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 reimbursement processes. E10.35 provides a clear indication of the severity of diabetic retinopathy, which is essential for treatment planning.

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 reimbursement processes. E10.35 provides a clear indication of the severity of diabetic retinopathy, which is essential for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. E10.35 provides a clear indication of the severity of diabetic retinopathy, which is essential for treatment planning.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.35?

Coding E10.35 accurately reflects the severity of a patient's diabetes and associated complications, which is crucial for appropriate management and reimbursement.