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ICD-10 Guide
ICD-10 CodesE10.3533

E10.3533

Billable

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

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

Code Description

ICD-10 E10.3533 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 (bilateral).

Key Diagnostic Point:

E10.3533 refers to a specific condition in patients with Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has led to traction retinal detachment, affecting both eyes but not involving the macula. Proliferative diabetic retinopathy is a severe form of diabetic eye disease where new, abnormal blood vessels grow on the retina, which can lead to vision loss. The traction retinal detachment occurs when these abnormal vessels pull on the retina, causing it to detach from the underlying tissue. This condition is particularly concerning as it can lead to significant visual impairment if not treated promptly. Management typically involves monitoring HbA1c levels to maintain glycemic control, as elevated levels can exacerbate retinal complications. Insulin therapy is often required to manage blood glucose levels effectively. Regular ophthalmologic evaluations are crucial for early detection and intervention, which may include laser therapy or surgical options to address the retinal detachment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition (bilateral traction retinal detachment)
  • Need for detailed documentation of diabetic retinopathy stages
  • Differentiation from other types of diabetic retinopathy
  • Management of insulin therapy and HbA1c levels

Audit Risk Factors

  • Inadequate documentation of the severity of retinopathy
  • Failure to document bilateral involvement
  • Lack of clarity on the management of insulin therapy
  • Inconsistent HbA1c level reporting

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including the extent of retinopathy and any surgical interventions performed.

Common Clinical Scenarios

Patients presenting with vision changes, requiring laser treatment or vitrectomy for retinal detachment.

Billing Considerations

Ensure clear documentation of the type of retinal detachment and its impact on vision.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the relationship between glycemic control and the development of diabetic retinopathy.

Coding Guidelines

Inclusion Criteria

Use E10.3533 When
  • According to ICD
  • 10 guidelines, this code should be used when the patient has a confirmed diagnosis of Type 1 diabetes with specific complications
  • Documentation must support the diagnosis, including the presence of proliferative diabetic retinopathy and details of the retinal detachment

Exclusion Criteria

Do NOT use E10.3533 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the extent of treatment and follow-up care.

Specialty Considerations

Ophthalmology should provide detailed reports on the procedure.

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 facilitating better management of diabetic conditions.

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 facilitating better management of diabetic conditions.

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.3533 accurately?

Accurate coding of E10.3533 is crucial for proper reimbursement, ensuring that patients receive appropriate care for their diabetes and its complications, and for tracking the prevalence of diabetic retinopathy in the population.