2025 ICD-10-CM code E08.3211
Diabetes due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye.
Medical necessity is established by the diagnosis of diabetes secondary to another condition and the presence of mild NPDR with macular edema affecting the right eye. Treatment is necessary to prevent vision loss and further complications from the diabetes and related eye conditions.
The physician is responsible for diagnosing and managing the underlying condition causing the diabetes, as well as treating the diabetic retinopathy and macular edema. This may involve consultation with ophthalmologists, endocrinologists, and other specialists depending on the underlying cause and severity of the condition.
In simple words: This code indicates diabetes resulting from another medical condition, accompanied by mild non-proliferative diabetic retinopathy (a condition where damage is limited to the retina and includes microaneurysms, hemorrhages, and abnormalities in the small blood vessels within the retina) with macular edema (swelling in the macula, the central part of the retina responsible for sharp vision) specifically affecting the right eye.
Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye. The underlying condition must be coded first.
Example 1: A patient with cystic fibrosis develops diabetes and is found to have mild NPDR with macular edema in their right eye., A patient receiving chemotherapy for pancreatic cancer develops diabetes and is subsequently diagnosed with mild NPDR with macular edema in their right eye., A patient with Cushing's syndrome develops diabetes and mild NPDR with macular edema affecting the right eye.
Documentation should include confirmation of the underlying condition causing diabetes, detailed ophthalmological findings indicating mild NPDR with macular edema in the right eye (including visual acuity assessments, funduscopic examination, and possibly OCT or fluorescein angiography), and details regarding diabetes management.
- Payment Status: Active
- Specialties:Endocrinology, Ophthalmology, Internal Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital (if admitted for complications)