2025 ICD-10-CM code E10.359
Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema.
The medical necessity for treatment is based on the severity of the PDR and the risk of vision loss.The physician must document the specific findings and justify the chosen treatment plan.
Clinicians should focus on managing both the diabetes and the proliferative diabetic retinopathy, aiming to stabilize blood sugar levels and prevent vision loss.Regular eye exams and control of blood sugar, blood pressure, and cholesterol are essential. Treatments may include laser therapy to shrink abnormal blood vessels and prevent further growth, and potentially anti-VEGF injections to reduce swelling and bleeding.In advanced cases, surgery (vitrectomy) may be necessary to remove blood or scar tissue from the eye.
In simple words: This code indicates that the patient has type 1 diabetes, which is a condition where the body doesn't produce enough insulin, leading to high blood sugar.As a result of the diabetes, they have developed a serious eye problem called proliferative diabetic retinopathy, where fragile new blood vessels grow in the eye and can bleed.Fortunately, they do not have swelling in the macula, the part of the eye responsible for central vision.
This code specifies a patient with type 1 diabetes experiencing proliferative diabetic retinopathy (PDR), an advanced stage of diabetic eye disease involving the growth of new, fragile blood vessels on the retina.It's crucial to note that this specific code indicates the absence of macular edema, a common complication of PDR characterized by swelling in the macula (the central part of the retina responsible for sharp vision).
Example 1: A 28-year-old patient with a long history of type 1 diabetes presents with blurred vision and floaters. Examination reveals new blood vessels on the retina, but no macular edema. Code E10.359 is applied., A 55-year-old with type 1 diabetes undergoes a routine eye exam. The ophthalmologist finds proliferative diabetic retinopathy without macular edema. Code E10.359 is used., A patient with type 1 diabetes and PDR previously treated with laser therapy is seen for follow-up. The PDR remains without macular edema. Code E10.359 is assigned.
Documentation should include detailed ophthalmological findings confirming the presence of proliferative diabetic retinopathy and the absence of macular edema.Records of blood sugar levels, HbA1c levels, and any other relevant medical history related to the patient's diabetes should also be included.
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital