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ICD-10 Guide
ICD-10 CodesE10.353

E10.353

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula

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

Code Description

ICD-10 E10.353 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula.

Key Diagnostic Point:

E10.353 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) accompanied by traction retinal detachment that does not involve the macula. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, leading to potential vision loss. In this case, the traction retinal detachment occurs due to the pulling of these abnormal vessels on the retina, but it spares the macula, which is crucial for central vision. Patients with this condition often have poorly controlled blood glucose levels, reflected in elevated HbA1c levels, which can exacerbate retinal complications. Management typically involves careful monitoring of blood glucose levels, insulin therapy, and possibly surgical intervention to address the retinal detachment. Regular eye examinations are essential for early detection and treatment of diabetic eye diseases.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of diabetic complications and their coding nuances.
  • Involves specific details about retinal conditions and their classifications.
  • Differentiation between types of retinal detachment is critical.
  • Documentation must clearly indicate the presence of traction detachment and its implications.

Audit Risk Factors

  • Inadequate documentation of the type of retinal detachment.
  • Failure to document HbA1c levels and diabetes management.
  • Misclassification of retinal conditions.
  • Lack of clarity on the involvement of the macula.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including imaging results.

Common Clinical Scenarios

Patients presenting with vision changes due to diabetic retinopathy.

Billing Considerations

Ensure documentation specifies the type of retinal detachment and its implications for treatment.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the patient's overall diabetes management plan and any changes in therapy.

Coding Guidelines

Inclusion Criteria

Use E10.353 When
  • According to ICD
  • 10 guidelines, E10
  • 353 should be used when the documentation clearly indicates Type 1 diabetes with proliferative diabetic retinopathy and traction retinal detachment not involving the macula
  • It is essential to ensure that the documentation supports the diagnosis and that all relevant details are included

Exclusion Criteria

Do NOT use E10.353 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 retinal damage.

Specialty Considerations

Ophthalmology must ensure accurate coding based on the type of retinopathy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetic complications, improving the accuracy of patient records and facilitating better management of diabetes-related conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetic complications, improving the accuracy of patient records and facilitating better management of diabetes-related conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of diabetic complications, improving the accuracy of patient records and facilitating better management of diabetes-related conditions.

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 the traction retinal detachment in E10.353?

Traction retinal detachment indicates a more severe form of diabetic retinopathy, requiring careful management and potential surgical intervention to prevent vision loss.

How does HbA1c level affect the coding of E10.353?

Elevated HbA1c levels indicate poor diabetes control, which is a critical factor in the development of complications like proliferative diabetic retinopathy and must be documented.