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ICD-10 Guide
ICD-10 CodesE10.352

E10.352

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula

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

Code Description

ICD-10 E10.352 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula.

Key Diagnostic Point:

E10.352 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has progressed to include traction retinal detachment affecting the macula. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, which can lead to bleeding and scarring. When these vessels pull on the retina, it can cause a traction retinal detachment, particularly when the macula, the central part of the retina responsible for sharp vision, is involved. This condition can lead to significant vision loss if not treated promptly. Management typically involves careful monitoring of blood glucose levels, maintaining HbA1c levels below 7% to prevent further complications, and may require surgical intervention such as vitrectomy to repair the detachment. Insulin management is crucial in controlling blood sugar levels to mitigate the risk of further retinal damage.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition requiring detailed documentation.
  • Need for accurate differentiation between types of diabetic retinopathy.
  • Involvement of multiple specialties (endocrinology, ophthalmology).
  • Potential for overlapping codes and conditions.

Audit Risk Factors

  • Inadequate documentation of the severity of retinopathy.
  • Failure to document HbA1c levels and diabetes management.
  • Lack of clarity on the involvement of the macula.
  • Misclassification of diabetic retinopathy stages.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with eye complications.

Billing Considerations

Ensure documentation reflects the relationship between diabetes control and retinopathy progression.

Ophthalmology

Documentation Requirements

Detailed eye examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with vision changes or retinal findings suggestive of PDR.

Billing Considerations

Document the extent of retinal detachment and any surgical interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.352 When
  • According to ICD
  • 10 coding guidelines, E10
  • 352 should be used when there is clear documentation of Type 1 diabetes with proliferative diabetic retinopathy and traction retinal detachment involving the macula
  • It is essential to ensure that all components of the diagnosis are documented to support the use of this specific code

Exclusion Criteria

Do NOT use E10.352 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67036CPT Code

Vitrectomy, mechanical

Clinical Scenario

Used in cases of traction retinal detachment.

Documentation Requirements

Document the indication for surgery and pre-operative assessments.

Specialty Considerations

Ophthalmology should provide detailed operative notes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, such as E10.352, which helps in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, such as E10.352, which helps in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, such as E10.352, which helps in better tracking of patient outcomes and resource allocation.

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 including HbA1c levels in documentation?

Including HbA1c levels is crucial as it reflects the patient's long-term glucose control and helps in assessing the risk of diabetic complications, including retinopathy.