2025 ICD-10-CM code E08.311
(Active) Effective Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus due to underlying condition 4 Feed
Diabetes mellitus due to an underlying condition with unspecified diabetic retinopathy and macular edema.
Medical necessity for services related to E08.311 must be supported by documentation of the diabetic retinopathy and macular edema, the underlying cause of the diabetes, and the need for treatment and management of these conditions.
Clinicians should document the underlying cause of the diabetes, the presence of retinopathy and macular edema, and assess and manage the patient's condition accordingly. Eye exams are crucial for early detection and treatment of diabetic retinopathy.
In simple words: This refers to diabetes caused by another health problem, along with damage to the back of the eye (retinopathy) and swelling in a critical part of the eye for sharp vision (macular edema).The specific type of eye damage isn't specified in the medical record.
Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema. This code identifies diabetes resulting from an underlying medical condition, accompanied by diabetic retinopathy and macular edema, where the specific type of retinopathy is not documented.
Example 1: A patient with cystic fibrosis develops diabetes and is found to have both diabetic retinopathy and macular edema.The type of retinopathy is not specified, so E08.311 is used., A patient with pancreatic cancer develops diabetes secondary to the malignancy and presents with unspecified diabetic retinopathy and macular edema. E08.311 is used in addition to the cancer code., A patient with Cushing's syndrome develops diabetes. During an eye exam, they are diagnosed with diabetic retinopathy and macular edema, but the specific type of retinopathy is not documented. E08.311 is used along with the code for Cushing's syndrome.
Documentation should clearly state the underlying condition causing the diabetes, the diagnosis of both diabetic retinopathy and macular edema.If the type of diabetic retinopathy (e.g., mild, moderate, nonproliferative, proliferative) is known, it should be documented for more specific coding.
** This code does not specify the laterality (right, left, bilateral) of macular edema or retinopathy. More specific codes are available if this information is known (e.g. E08.3211 for mild nonproliferative diabetic retinopathy with macular edema, right eye). Remember to code the underlying condition first.
- Payment Status: Active
- Specialties:Endocrinology, Ophthalmology, Internal Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic, Federally Qualified Health Center, etc.