ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesE10.3513

E10.3513

Billable

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

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

Code Description

ICD-10 E10.3513 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema (bilateral).

Key Diagnostic Point:

E10.3513 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) with bilateral macular edema. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, which can lead to vision loss. The presence of macular edema indicates that fluid has accumulated in the macula, the central part of the retina responsible for sharp vision. This condition is often associated with poor glycemic control, typically reflected in elevated HbA1c levels, which indicate chronic hyperglycemia. Management of this condition often requires intensive insulin therapy and regular monitoring of blood glucose levels to maintain HbA1c within target ranges. Patients may also require interventions such as laser photocoagulation or intravitreal injections to manage the complications of retinopathy effectively. Regular eye examinations are crucial for early detection and treatment of diabetic eye diseases.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of diabetes complications and their coding
  • Involves multiple conditions (diabetes, retinopathy, macular edema)
  • Need for precise documentation of clinical findings
  • Potential for misclassification with other types of diabetic retinopathy

Audit Risk Factors

  • Inadequate documentation of retinopathy severity
  • Failure to document HbA1c levels
  • Lack of evidence for bilateral involvement
  • Misinterpretation of diabetic retinopathy stages

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of diabetes management, including insulin regimens and HbA1c levels.

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with eye complications.

Billing Considerations

Ensure documentation reflects the severity of diabetes and associated complications.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports detailing findings of retinopathy and macular edema.

Common Clinical Scenarios

Patients undergoing treatment for diabetic retinopathy.

Billing Considerations

Document the specific type of retinopathy and treatment provided.

Coding Guidelines

Inclusion Criteria

Use E10.3513 When
  • According to ICD
  • 10 guidelines, E10
  • 3513 should be used when a patient with Type 1 diabetes has been diagnosed with proliferative diabetic retinopathy and macular edema
  • Documentation must clearly indicate the presence of both conditions, and the bilateral nature of the edema must be specified

Exclusion Criteria

Do NOT use E10.3513 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67028CPT Code

Laser photocoagulation

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 linked to the diagnosis of E10.3513.

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 claims and facilitating better patient management. E10.3513 provides a clear indication of the severity of diabetic retinopathy and associated macular edema, which is crucial 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 claims and facilitating better patient management. E10.3513 provides a clear indication of the severity of diabetic retinopathy and associated macular edema, which is crucial for treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of claims and facilitating better patient management. E10.3513 provides a clear indication of the severity of diabetic retinopathy and associated macular edema, which is crucial for treatment planning.

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 E10.3513?

Coding E10.3513 accurately reflects the severity of diabetic retinopathy and macular edema in patients with Type 1 diabetes, which is essential for appropriate treatment and management.

How often should patients with E10.3513 be monitored?

Patients with E10.3513 should have regular eye examinations, typically every 6 to 12 months, and their HbA1c levels should be monitored quarterly to ensure effective diabetes management.