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ICD-10 Guide
ICD-10 CodesE10.3519

E10.3519

Billable

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

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

Code Description

ICD-10 E10.3519 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema (unspecified eye).

Key Diagnostic Point:

E10.3519 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) accompanied by macular edema in an unspecified eye. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, which can lead to vision loss. Macular edema occurs when fluid accumulates in the macula, the central part of the retina responsible for sharp vision. This condition is often a result of chronic hyperglycemia, which can lead to damage of the retinal blood vessels. Patients with Type 1 diabetes typically require insulin therapy to manage their blood glucose levels effectively. Regular monitoring of HbA1c levels is crucial, as elevated levels indicate poor glycemic control, increasing the risk of diabetic complications such as retinopathy. The management of this condition often involves a multidisciplinary approach, including endocrinologists, ophthalmologists, and diabetes educators, to optimize blood sugar control and monitor for ocular complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of diabetes-related complications and their coding.
  • Need for precise documentation of eye conditions and their severity.
  • Differentiation between types of diabetic retinopathy and associated conditions.
  • Management of insulin therapy and its impact on complications.

Audit Risk Factors

  • Inadequate documentation of the severity of retinopathy.
  • Failure to document HbA1c levels and diabetes management.
  • Misclassification of the type of diabetic retinopathy.
  • Lack of follow-up documentation for eye examinations.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with uncontrolled diabetes and complications.

Billing Considerations

Ensure comprehensive documentation of diabetes management and any referrals to ophthalmology.

Ophthalmology

Documentation Requirements

Thorough eye examination reports detailing the presence and severity of retinopathy and edema.

Common Clinical Scenarios

Patients with vision changes due to diabetic retinopathy.

Billing Considerations

Document the specific findings of the eye examination and any treatments provided.

Coding Guidelines

Inclusion Criteria

Use E10.3519 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the type of diabetes, the presence of complications, and the specific eye affected
  • Include HbA1c levels and treatment plans in the documentation

Exclusion Criteria

Do NOT use E10.3519 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used for routine eye exams in patients with diabetes.

Documentation Requirements

Document the findings of the eye examination and any treatments provided.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinopathy findings.

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. E10.3519 provides a clear distinction for Type 1 diabetes patients with severe ocular complications.

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. E10.3519 provides a clear distinction for Type 1 diabetes patients with severe ocular complications.

Reimbursement & Billing Impact

reimbursement processes. E10.3519 provides a clear distinction for Type 1 diabetes patients with severe ocular complications.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3519?

Coding E10.3519 accurately reflects the severity of complications associated with Type 1 diabetes, which is crucial for appropriate management and reimbursement.