2025 ICD-10-CM code E11.3
(Active) Effective Date: N/A Endocrine, nutritional and metabolic diseases - E11 4 Feed
Type 2 diabetes mellitus with ophthalmic complications.
Medical necessity for services related to E11.3 is established by the presence of documented ophthalmic complications directly related to type 2 diabetes.These complications must impact the patient's vision or threaten vision loss.Appropriate documentation linking the eye condition to diabetes is crucial.
Clinicians should diagnose based on patient history, physical and eye exams, and relevant symptoms. Laboratory tests like fasting plasma glucose, 2-hour plasma glucose, HbA1c, lipid profile, and urinary albumin are essential. Treatment may involve eye surgery, lifestyle changes, dietary adjustments, exercise, medication, and insulin therapy.
In simple words: This code refers to eye problems that can occur in people with type 2 diabetes. When someone has type 2 diabetes, their body doesn't use insulin properly, and this can lead to high blood sugar. Over time, high blood sugar can damage the blood vessels in the back of the eye, causing vision problems.
Type 2 diabetes mellitus with ophthalmic complications refers to a condition where a patient with type 2 diabetes experiences eye-related problems due to the disease.Type 2 diabetes is characterized by the body's ineffective use of insulin, a hormone that regulates blood sugar.Over time, high blood sugar levels can damage the blood vessels in the retina, the light-sensitive tissue at the back of the eye.This damage can lead to various ophthalmic complications.
Example 1: A 60-year-old patient with a history of type 2 diabetes presents with blurred vision and floaters. Upon examination, the ophthalmologist diagnoses diabetic retinopathy and macular edema., A 50-year-old patient with poorly controlled type 2 diabetes complains of sudden vision loss.Diagnosis reveals a vitreous hemorrhage secondary to proliferative diabetic retinopathy., A 70-year-old patient with long-standing type 2 diabetes develops neovascular glaucoma, requiring surgical intervention to manage intraocular pressure.
Documentation should include details of the patient's diabetes history, blood sugar control, duration of diabetes, specific eye-related symptoms, ophthalmological examination findings (including visual acuity, fundus examination), and any diagnostic tests performed (e.g., fluorescein angiography, optical coherence tomography).
** Timely diagnosis and management are essential to prevent vision loss from diabetic eye disease.Regular eye exams are crucial for patients with type 2 diabetes.Patient education on managing blood sugar, blood pressure, and cholesterol levels is also important in reducing the risk of developing or worsening diabetic eye problems.
- Specialties:Endocrinology, Ophthalmology, Internal Medicine, Family Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital,Ambulatory Surgical Center, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home