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ICD-10 Guide
ICD-10 CodesE10.3552

E10.3552

Billable

Type 1 diabetes mellitus with stable proliferative diabetic retinopathy (left eye)

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

Code Description

ICD-10 E10.3552 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with stable proliferative diabetic retinopathy (left eye).

Key Diagnostic Point:

E10.3552 refers to Type 1 diabetes mellitus characterized by the presence of stable proliferative diabetic retinopathy in the left eye. Type 1 diabetes is an autoimmune condition where the pancreas produces little to no insulin, leading to elevated blood glucose levels. Proliferative diabetic retinopathy is a severe complication of diabetes, marked by the growth of new blood vessels in the retina, which can lead to vision loss. The term 'stable' indicates that the condition has not progressed or worsened, which is crucial for treatment planning and monitoring. Management of Type 1 diabetes typically involves insulin therapy, regular monitoring of blood glucose levels, and maintaining HbA1c levels below 7% to prevent complications. The presence of diabetic retinopathy necessitates regular ophthalmologic evaluations to monitor retinal health and prevent further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Specificity of the eye affected (left eye)
  • Differentiation between stable and unstable retinopathy
  • Need for accurate documentation of diabetes type
  • Management of insulin therapy and HbA1c levels

Audit Risk Factors

  • Inadequate documentation of retinopathy status
  • Failure to specify the eye affected
  • Incorrect coding of diabetes type
  • Lack of evidence for stable condition

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 blood glucose levels or complications related to diabetes.

Billing Considerations

Ensure documentation reflects the type of diabetes and any complications accurately.

Ophthalmology

Documentation Requirements

Comprehensive eye examination reports, including findings related to diabetic retinopathy.

Common Clinical Scenarios

Routine eye exams for diabetic patients, monitoring for progression of retinopathy.

Billing Considerations

Document the stability of retinopathy and any treatment provided.

Coding Guidelines

Inclusion Criteria

Use E10.3552 When
  • According to ICD
  • 10 guidelines, E10
  • 3552 should be used when a patient has Type 1 diabetes with stable proliferative diabetic retinopathy in the left eye
  • It is essential to document the stability of the retinopathy and the specific eye affected

Exclusion Criteria

Do NOT use E10.3552 When
  • Exclusion criteria include other types of diabetic retinopathy or conditions unrelated to diabetes

Related ICD-10 Codes

Related CPT Codes

92014CPT Code

Ophthalmological examination, comprehensive, established patient

Clinical Scenario

Used during routine eye exams for diabetic patients.

Documentation Requirements

Document findings related to diabetic retinopathy and any treatment provided.

Specialty Considerations

Ophthalmologists should ensure detailed documentation of retinopathy status.

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 diabetic retinopathy. This specificity aids 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 diabetic retinopathy. This specificity aids 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 diabetic retinopathy. This specificity aids in better tracking of patient outcomes and resource allocation.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What does 'stable' mean in the context of diabetic retinopathy?

In this context, 'stable' indicates that the proliferative diabetic retinopathy has not progressed or worsened since the last evaluation, which is important for treatment planning.