2025 ICD-10-CM code E10.311
(Active) Effective Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus 4 Feed
Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema.
Medical necessity for this code is established by the presence of type 1 diabetes and documented macular edema as a complication of diabetic retinopathy. Further testing and treatment are often necessary to preserve vision.
Diagnosis and management of type 1 diabetes and its associated ophthalmic complications, including regular eye exams, blood sugar control, and treatment of macular edema.
In simple words: This code indicates that the patient has type 1 diabetes, an autoimmune disease where the body doesn't produce enough insulin, leading to high blood sugar. This high blood sugar has caused damage to the blood vessels in the back of the eye (retina), specifically in the macula (area responsible for central vision), leading to swelling and blurred vision.
This code describes a patient with type 1 diabetes who has developed diabetic retinopathy with macular edema. The specific type of retinopathy (e.g., mild, moderate, severe nonproliferative or proliferative) is not specified.
Example 1: A patient with long-standing type 1 diabetes presents with blurred vision and is diagnosed with macular edema, but the specific type of diabetic retinopathy is not yet determined., A patient with type 1 diabetes undergoes a routine eye exam which reveals macular edema, confirming the progression of diabetic retinopathy., A patient with type 1 diabetes and existing diabetic retinopathy experiences worsening vision and is found to have developed macular edema.
Documentation should include the type of diabetes, presence of macular edema, any findings from eye exams (e.g., ophthalmoscopy, fluorescein angiography), and HbA1c levels. If the type of diabetic retinopathy is later determined, the code should be updated accordingly.
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- Place of Service:Office, Outpatient Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home