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ICD-10 Guide
ICD-10 CodesE10.3592

E10.3592

Billable

Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema (left eye)

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

Code Description

ICD-10 E10.3592 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema (left eye).

Key Diagnostic Point:

E10.3592 refers to Type 1 diabetes mellitus characterized by the presence of proliferative diabetic retinopathy (PDR) in the left eye without associated macular edema. 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. This condition arises due to chronic hyperglycemia, which damages the retinal blood vessels. In patients with Type 1 diabetes, the onset of PDR typically occurs after several years of diabetes, often when HbA1c levels are poorly controlled. Management of this condition involves regular ophthalmologic examinations, strict glycemic control, and may include laser photocoagulation therapy to prevent further vision loss. The absence of macular edema indicates that while there is significant retinal damage, the central vision area remains unaffected, which is a critical distinction in treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between types of diabetic retinopathy
  • Need for precise documentation of eye involvement
  • Understanding of diabetes management and HbA1c levels
  • Knowledge of associated complications and their coding

Audit Risk Factors

  • Inadequate documentation of eye examination findings
  • Failure to specify the absence of macular edema
  • Misclassification of diabetic retinopathy severity
  • Inconsistent HbA1c documentation

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Detailed retinal examination findings, including presence or absence of macular edema and treatment plans.

Common Clinical Scenarios

Patients presenting with vision changes, routine diabetic eye exams, and follow-up after laser treatment.

Billing Considerations

Ensure clarity in documenting the type of retinopathy and any interventions performed.

Endocrinology

Documentation Requirements

Comprehensive diabetes management records, including HbA1c levels and treatment regimens.

Common Clinical Scenarios

Management of diabetes with complications, routine follow-ups, and adjustments in insulin therapy.

Billing Considerations

Document the patient's overall diabetes control and any referrals to ophthalmology.

Coding Guidelines

Inclusion Criteria

Use E10.3592 When
  • According to ICD
  • 10 coding guidelines, E10
  • 3592 should be used when the patient has Type 1 diabetes with proliferative diabetic retinopathy specifically in the left eye and without macular edema
  • It is essential to document the specific eye affected and the absence of macular edema to ensure accurate coding

Exclusion Criteria

Do NOT use E10.3592 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

67228CPT Code

Laser photocoagulation of retina

Clinical Scenario

Used for treatment of proliferative diabetic retinopathy.

Documentation Requirements

Document the indication for laser treatment and the specific eye treated.

Specialty Considerations

Ophthalmology must ensure that the procedure is linked to the correct diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

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

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

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 the absence of macular edema?

Specifying the absence of macular edema is crucial as it affects treatment options and prognosis. It indicates that while there is significant retinal damage, the central vision area remains unaffected, which is important for management strategies.