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ICD-10 Guide
ICD-10 CodesE10.3512

E10.3512

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema (left eye)

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

Code Description

ICD-10 E10.3512 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema (left eye).

Key Diagnostic Point:

E10.3512 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) with macular edema in the left eye. PDR is a severe form of diabetic retinopathy that occurs when new, abnormal blood vessels grow in the retina, which can lead to vision loss. Macular edema, a common complication, involves the accumulation of fluid in the macula, the central part of the retina responsible for sharp vision. Patients with Type 1 diabetes often have difficulty managing their blood glucose levels, which can lead to chronic hyperglycemia and subsequent vascular damage. The presence of PDR with macular edema indicates a significant progression of diabetic eye disease, necessitating careful monitoring and management, including potential interventions such as laser therapy or anti-VEGF injections. Regular eye examinations and maintaining optimal HbA1c levels are crucial in preventing further complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition (left eye vs. right eye)
  • Inclusion of multiple complications (PDR and macular edema)
  • Need for precise documentation of diabetes management
  • Potential for overlapping codes in diabetic complications

Audit Risk Factors

  • Inadequate documentation of eye examinations
  • Failure to document HbA1c levels
  • Lack of clarity on the severity of retinopathy
  • Misidentification of eye involvement (left vs. right)

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed eye examination reports, including findings related to retinopathy and macular edema.

Common Clinical Scenarios

Patients presenting with vision changes, routine diabetic eye exams, and follow-ups after treatment for retinopathy.

Billing Considerations

Ensure clear documentation of the type and severity of retinopathy and any treatments administered.

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including HbA1c levels and insulin therapy details.

Common Clinical Scenarios

Patients with poorly controlled diabetes, those experiencing complications, and routine follow-ups.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use E10.3512 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the patient's condition and that all documentation supports the diagnosis
  • Include details about the patient's diabetes management and any related complications

Exclusion Criteria

Do NOT use E10.3512 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

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

Specialty Considerations

Ophthalmologists should ensure that the procedure is justified based on the severity of the retinopathy.

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 data collection and reimbursement processes. E10.3512 provides a clear indication of the severity of diabetic retinopathy and its impact on patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of data collection and reimbursement processes. E10.3512 provides a clear indication of the severity of diabetic retinopathy and its impact on patient care.

Reimbursement & Billing Impact

reimbursement processes. E10.3512 provides a clear indication of the severity of diabetic retinopathy and its impact on patient care.

Resources

Clinical References

  • •
    American Diabetes Association
  • •
    American Academy of Ophthalmology

Coding & Billing References

  • •
    American Diabetes Association
  • •
    American Academy of Ophthalmology

Frequently Asked Questions

What is the significance of coding E10.3512?

Coding E10.3512 accurately reflects the presence of severe diabetic eye complications, which is crucial for appropriate management and treatment planning. It also impacts reimbursement and quality metrics for diabetes care.