2025 ICD-10-CM code E08.35
Diabetes mellitus due to an underlying condition with proliferative diabetic retinopathy (PDR).
Seventh character is required to specify laterality and macular edema status.
The medical necessity for treatment of both the diabetes and the retinopathy must be documented. This includes the severity of the retinopathy, its impact on vision, and the treatment plan.
Clinicians should diagnose based on history, physical and ophthalmic examination, and signs and symptoms. Laboratory tests include blood glucose, HbA1c, lipid profile, urine and stool analysis. Imaging tests include abdominal X-ray, ultrasound, fluorescein angiography, OCT, and color fundus photography. Treatment focuses on metabolic and blood pressure control, photocoagulation (laser), anti-VEGF therapy, steroids, and vitrectomy if necessary. Underlying conditions are treated based on their specific needs, while diabetes management utilizes insulin or non-insulin therapies.
In simple words: This code describes a type of diabetes caused by another health problem, which has also led to eye damage involving abnormal blood vessel growth in the retina.
Diabetes mellitus resulting from an underlying condition, accompanied by proliferative diabetic retinopathy, characterized by the growth of new blood vessels on the retina (neovascularization elsewhere).
Example 1: A patient with cystic fibrosis develops diabetes and is later diagnosed with proliferative diabetic retinopathy., A patient with a malignant neoplasm of the pancreas develops diabetes and is found to have proliferative diabetic retinopathy on an ophthalmological exam., A patient with long-standing Cushing's syndrome develops diabetes and presents with vision changes, subsequently diagnosed with proliferative diabetic retinopathy.
Documentation should include the type of diabetes, the underlying condition causing it, details of the proliferative diabetic retinopathy (including laterality and presence of macular edema if applicable), and any other related complications.
** Excludes1: drug or chemical induced diabetes mellitus (E09.-) gestational diabetes (O24.4-) neonatal diabetes mellitus (P70.2) postpancreatectomy diabetes mellitus (E13.-) postprocedural diabetes mellitus (E13.-) secondary diabetes mellitus NEC (E13.-) type 1 diabetes mellitus (E10.-) type 2 diabetes mellitus (E11.-)
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic