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ICD-10 Guide
ICD-10 CodesE10.3539

E10.3539

Billable

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

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

Code Description

ICD-10 E10.3539 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 (unspecified eye).

Key Diagnostic Point:

E10.3539 refers to a specific complication of Type 1 diabetes mellitus characterized by proliferative diabetic retinopathy (PDR) that has progressed to include traction retinal detachment, but notably does not involve the macula. PDR is a severe form of diabetic retinopathy where new, abnormal blood vessels grow on the retina, which can lead to vision loss. The traction retinal detachment occurs when these new vessels pull on the retina, causing it to detach from the underlying tissue. This condition is serious and requires prompt intervention to prevent irreversible vision loss. Management typically involves monitoring HbA1c levels to ensure optimal glycemic control, as elevated levels can exacerbate retinal complications. Insulin therapy is often necessary to manage blood glucose levels effectively. Regular eye examinations are crucial for early detection and treatment of diabetic retinopathy, and patients may require laser therapy or surgical intervention to address the detachment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Specificity of the condition requires detailed documentation.
  • Differentiation between types of diabetic retinopathy.
  • Need for precise eye involvement documentation.
  • Management of multiple complications in diabetes.

Audit Risk Factors

  • Inadequate documentation of eye examination findings.
  • Failure to specify the type of retinal detachment.
  • Lack of clarity on the patient's diabetes management plan.
  • Inconsistent HbA1c reporting.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, treatment plans, and follow-up care.

Common Clinical Scenarios

Patients presenting with vision changes, requiring laser treatment for PDR.

Billing Considerations

Ensure clear documentation of retinal findings and treatment outcomes.

Endocrinology

Documentation Requirements

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

Common Clinical Scenarios

Patients with poorly controlled diabetes presenting with complications.

Billing Considerations

Document the relationship between glycemic control and retinal complications.

Coding Guidelines

Inclusion Criteria

Use E10.3539 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Include details about the type of diabetic retinopathy and any associated complications
  • Ensure that the code reflects the most specific condition documented

Exclusion Criteria

Do NOT use E10.3539 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 indication for laser treatment and the extent of the procedure.

Specialty Considerations

Ophthalmology should ensure detailed records of the procedure and patient response.

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, improving the accuracy of patient records and reimbursement processes. E10.3539 reflects the need for detailed documentation of diabetic retinopathy and its complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding diabetes-related complications, improving the accuracy of patient records and reimbursement processes. E10.3539 reflects the need for detailed documentation of diabetic retinopathy and its complications.

Reimbursement & Billing Impact

reimbursement processes. E10.3539 reflects the need for detailed documentation of diabetic retinopathy and its complications.

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 specifying traction retinal detachment?

Specifying traction retinal detachment is crucial as it indicates a more severe complication of diabetic retinopathy that requires different management strategies compared to non-traction detachment.