2025 ICD-10-CM code E10.33
(Active) Effective Date: N/A Endocrine, nutritional and metabolic diseases - Diabetes mellitus 4 Feed
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy.
The medical necessity for the diagnosis and management of moderate NPDR in type 1 diabetes is established by the presence of characteristic retinal lesions and associated visual symptoms. Regular eye exams are medically necessary for individuals with diabetes to detect and monitor the progression of retinopathy and prevent vision loss.Treatment, such as laser photocoagulation or anti-VEGF injections, is medically necessary when indicated to address specific complications like macular edema or proliferative retinopathy.
Clinicians should document the type of diabetes, the stage of diabetic retinopathy (moderate NPDR), and specify whether macular edema is present or absent. Additionally, the affected eye (right, left, or bilateral) must be documented. Thorough documentation of clinical findings from ophthalmological examinations, including the presence of microaneurysms, hemorrhages, and IRMA, is crucial for accurate coding.
In simple words: This code describes a condition where a person with type 1 diabetes has eye damage due to moderately severe changes in the blood vessels of the retina.Their eyes aren't getting enough blood because of the diabetes, and the body is starting to grow new, weaker blood vessels to compensate. It hasn't reached the most severe stage yet, but there are signs of damage like tiny bulges and bleeding in the blood vessels.
Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy (NPDR) is a chronic autoimmune disease characterized by the destruction of pancreatic beta cells, resulting in insufficient insulin production and elevated blood glucose levels.This uncontrolled hyperglycemia gradually damages the retinal blood vessels, leading to the moderate development of new, abnormal vessels.NPDR involves retinal lesions such as microaneurysms, dot and blot hemorrhages, splinter hemorrhages, and intraretinal microvascular abnormalities (IRMA).Moderate NPDR is characterized by the presence of severe dot hemorrhages and microaneurysms in one to three quadrants of the retina.
Example 1: A patient with a long-standing history of type 1 diabetes presents with blurred vision and floaters.Ophthalmological examination reveals severe dot hemorrhages and microaneurysms in two quadrants of the retina, consistent with moderate NPDR. Macular edema is not present., A pregnant woman with type 1 diabetes undergoes an eye exam that shows moderate NPDR with severe dot hemorrhages in one quadrant and microaneurysms in three quadrants. There is no macular edema., A patient with type 1 diabetes and known mild NPDR returns for follow-up.The ophthalmologist notes progression to moderate NPDR, with the development of severe dot hemorrhages and microaneurysms in three quadrants of the retina, without macular edema.
Documentation must include the type of diabetes (type 1), the severity of NPDR (moderate), the presence or absence of macular edema, and the laterality (which eye is affected or if both are).Detailed findings from the ophthalmological exam, such as the presence of microaneurysms, hemorrhages, and IRMA, should be clearly documented.
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ophthalmology Clinic