2025 ICD-10-CM code E13.359
A specific type of diabetes mellitus characterized by the proliferation of blood vessels in the retina without macular edema.
Applicable modifiers might depend on the specific procedures performed related to the retinopathy (e.g., laser photocoagulation).
Medical necessity for services related to this code hinges on the demonstrated presence of the specific type of diabetes and the confirmed diagnosis of proliferative diabetic retinopathy without macular edema. This diagnosis justifies interventions like ophthalmological exams, imaging studies, and treatments aimed at preventing vision loss.
Diagnosis and management of this condition fall under the purview of endocrinologists, ophthalmologists, and potentially other specialists depending on the patient's overall health.The physician is responsible for confirming the diagnosis, assessing the severity of retinopathy, and implementing or referring the patient for appropriate treatment.
In simple words: This code describes a specific type of diabetes where the body doesn't process sugar correctly, causing abnormal blood vessel growth in the back of the eye (retina), but without swelling in the central part of the retina (macula).
Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema refers to a condition where a patient has a form of diabetes not otherwise categorized, accompanied by the growth of new blood vessels on the retina (neovascularization), a hallmark of proliferative diabetic retinopathy, but without swelling in the macula (macular edema).
Example 1: A patient with latent autoimmune diabetes in adults (LADA) presents with vision changes. Upon examination, they are found to have proliferative diabetic retinopathy without macular edema. , A patient with diabetes due to a rare genetic mutation develops proliferative diabetic retinopathy without macular edema. This requires specialized care beyond standard type 1 or type 2 diabetes management., A patient with post-pancreatectomy diabetes develops proliferative diabetic retinopathy without macular edema requiring ophthalmological intervention alongside their diabetes management.
Documentation should clearly specify the type of diabetes, the presence of proliferative diabetic retinopathy, and the absence of macular edema. Detailed ophthalmological findings are crucial, including descriptions of neovascularization and the state of the macula. Results of diagnostic tests, such as fluorescein angiography and optical coherence tomography (OCT), should also be included.
** This code is distinct from other diabetic retinopathy codes that specify macular edema, highlighting the importance of accurate documentation. While this code itself does not specify the laterality, a seventh character is required to indicate whether the condition affects the right eye, left eye, both eyes, or is of unspecified laterality.
- Payment Status: Active
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center