2025 ICD-10-CM code E11.35
Type 2 diabetes mellitus with proliferative diabetic retinopathy.
Medical necessity is established by the presence of type 2 diabetes and the diagnosis of proliferative diabetic retinopathy, impacting visual function.Treatment is necessary to prevent further vision loss and potentially blindness.
The physician is responsible for diagnosing and managing the patient's type 2 diabetes and the associated proliferative diabetic retinopathy. This includes regular eye exams, blood sugar control, and appropriate treatments for both conditions. Referral to an ophthalmologist is crucial for managing PDR.
In simple words: This code indicates that someone with type 2 diabetes has a serious eye problem called proliferative diabetic retinopathy. This happens when the small blood vessels in the back of the eye become damaged and new, weaker vessels start to grow. These new vessels can bleed and cause vision problems.
This code describes a patient with type 2 diabetes who has developed proliferative diabetic retinopathy (PDR), a severe eye condition.PDR is characterized by the growth of new, fragile blood vessels in the retina, which can leak and bleed, leading to vision loss. It is a more advanced stage of diabetic retinopathy and requires prompt medical attention.
Example 1: A 60-year-old patient with a long history of poorly controlled type 2 diabetes presents with blurred vision and floaters.Examination reveals neovascularization and vitreous hemorrhage, confirming proliferative diabetic retinopathy., A 50-year-old with type 2 diabetes, managed with oral medication, attends a routine eye exam.The ophthalmologist detects early neovascularization, indicating proliferative diabetic retinopathy, despite no vision changes., A 70-year-old patient with type 2 diabetes experiences sudden vision loss.Diagnostic tests show tractional retinal detachment resulting from advanced proliferative diabetic retinopathy, requiring urgent surgical intervention.
Documentation should include the type and duration of diabetes, blood sugar levels (HbA1c), details of the eye exam findings (e.g., neovascularization, vitreous hemorrhage, macular edema), visual acuity measurements, and treatment plan.
** This code does not distinguish between type 1 and type 2 diabetes. If both conditions exist, the code for type 1 diabetes with proliferative diabetic retinopathy (E10.35) would be more appropriate.
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital