2025 ICD-10-CM code E08.359
(Active) Effective Date: N/A Revision Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema 4 Feed
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema.
Medical necessity for services related to this code hinges on the diagnosis and management of both the underlying condition and the diabetic retinopathy.The documentation must support the need for interventions such as photocoagulation, anti-VEGF injections, or vitrectomy based on the severity of the retinopathy.
Clinicians should document the underlying condition causing the diabetes, the stage and characteristics of the proliferative diabetic retinopathy, and the absence of macular edema.Detailed ophthalmological findings are crucial. The underlying condition like cystic fibrosis, neoplasm, malnutrition, pancreatitis, or Cushing syndrome must be coded separately.
In simple words: This code indicates diabetes resulting from another health issue, along with eye damage (proliferative diabetic retinopathy) but without swelling in the central part of the eye (macula).
This code signifies diabetes mellitus stemming from an underlying condition, accompanied by proliferative diabetic retinopathy (PDR) but without macular edema.PDR is characterized by the growth of new blood vessels in the retina due to oxygen deprivation.These fragile vessels can leak or bleed, leading to vision impairment. The absence of macular edema indicates that fluid has not accumulated in the macula, the central part of the retina responsible for sharp vision.
Example 1: A patient with cystic fibrosis develops diabetes and is later diagnosed with proliferative diabetic retinopathy without macular edema., A patient with a pancreatic tumor develops diabetes and is found to have proliferative diabetic retinopathy without macular edema., A patient with long-standing Cushing's syndrome develops diabetes and proliferative diabetic retinopathy without macular edema.
Documentation should include the type of diabetes, the underlying condition, details of the ophthalmological examination confirming PDR and the absence of macular edema, and any treatment provided.Lab results (HbA1c, fasting glucose) and imaging reports (fluorescein angiography, OCT) should also be included.
** It's crucial to distinguish between diabetic retinopathy with and without macular edema as treatment and prognosis can differ. This code requires a 7th character to specify the laterality (eye affected).
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital,Ambulatory Surgical Center