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ICD-10 Guide
ICD-10 CodesE10.3553

E10.3553

Billable

Type 1 diabetes mellitus with stable proliferative diabetic retinopathy (bilateral)

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

Code Description

ICD-10 E10.3553 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with stable proliferative diabetic retinopathy (bilateral).

Key Diagnostic Point:

E10.3553 refers to Type 1 diabetes mellitus characterized by the presence of stable proliferative diabetic retinopathy in both eyes. Proliferative diabetic retinopathy (PDR) is a severe form of diabetic eye disease that occurs when new, abnormal blood vessels grow on the retina, which can lead to vision loss. In patients with Type 1 diabetes, the onset of diabetic retinopathy is often linked to the duration of diabetes and poor glycemic control. The term 'stable' indicates that the condition has not progressed or worsened, which is crucial for management and treatment planning. Regular monitoring of HbA1c levels is essential, as maintaining these levels below 7% can help prevent the progression of diabetic complications, including retinopathy. Insulin management is critical in Type 1 diabetes, as patients require exogenous insulin to maintain blood glucose levels. The presence of bilateral PDR necessitates close collaboration between endocrinologists and ophthalmologists to ensure comprehensive care and timely interventions to preserve vision.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of diabetes types and their complications
  • Need for accurate documentation of retinopathy status
  • Differentiation between stable and unstable conditions
  • Potential for co-morbidities affecting coding

Audit Risk Factors

  • Inadequate documentation of retinopathy status
  • Failure to document HbA1c levels
  • Misclassification of the type of diabetes
  • Lack of follow-up notes on eye examinations

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 sugar levels and complications.

Billing Considerations

Ensure that all diabetes-related complications are documented and linked to the primary diagnosis.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Routine eye exams for diabetic patients and management of retinopathy.

Billing Considerations

Document the stability of retinopathy and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.3553 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's diabetes type, complications, and the stability of the retinopathy
  • Include HbA1c levels and insulin management details as part of the clinical picture

Exclusion Criteria

Do NOT use E10.3553 When
No specific exclusions found.

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 visual acuity.

Specialty Considerations

Ophthalmologists should ensure thorough documentation of retinopathy status.

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 chronic 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 chronic 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 chronic conditions.

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?

Stable diabetic retinopathy indicates that the condition has not progressed or worsened over time, which is crucial for treatment planning and monitoring.