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ICD-10 Guide
ICD-10 CodesE10.3559

E10.3559

Billable

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

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

Code Description

ICD-10 E10.3559 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with stable proliferative diabetic retinopathy (unspecified eye).

Key Diagnostic Point:

E10.3559 refers to Type 1 diabetes mellitus characterized by the presence of stable proliferative diabetic retinopathy in an unspecified eye. Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes that occurs when new blood vessels grow in the retina, which can lead to vision loss. In patients with Type 1 diabetes, the onset of diabetic retinopathy typically occurs after several years of hyperglycemia. The term 'stable' indicates that the condition has not progressed or worsened, which is crucial for management and treatment planning. Effective management of Type 1 diabetes involves maintaining optimal blood glucose levels, often monitored through HbA1c levels, which should ideally be below 7% to minimize complications. Insulin therapy is the cornerstone of treatment for Type 1 diabetes, and regular eye examinations are essential for early detection and management of diabetic retinopathy. This code is vital for accurately documenting the patient's condition and ensuring appropriate care and follow-up.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between stable and unstable diabetic retinopathy
  • Understanding the nuances of Type 1 diabetes management
  • Monitoring and documenting HbA1c levels accurately
  • Identifying the unspecified eye in clinical documentation

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 regimen and HbA1c levels.

Common Clinical Scenarios

Routine follow-ups for diabetes management, insulin adjustments, and complications assessment.

Billing Considerations

Ensure comprehensive documentation of all diabetes-related complications and treatments.

Ophthalmology

Documentation Requirements

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

Common Clinical Scenarios

Annual diabetic eye exams, treatment of retinal complications, and monitoring of retinopathy progression.

Billing Considerations

Document the stability of retinopathy and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use E10.3559 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the documentation supports the diagnosis
  • Include specific details about the patient's diabetes management and retinopathy status

Exclusion Criteria

Do NOT use E10.3559 When
  • Exclude codes for other types of diabetes or conditions not related to diabetic retinopathy

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 of the eye exam and any changes in retinopathy status.

Specialty Considerations

Ophthalmologists should ensure detailed notes on retinopathy.

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 proliferative diabetic retinopathy?

Stable proliferative diabetic retinopathy indicates that the condition has not progressed or worsened since the last examination, and there are no new complications.