2025 ICD-10-CM code E11.359
Effective Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus 4 Feed
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema.
Medical necessity for services related to E11.359 is established by the presence of PDR, which poses a risk to vision. Intervention aims to prevent complications like vitreous hemorrhage and retinal detachment.
Physicians managing patients with E11.359 need to monitor blood glucose levels, blood pressure, and cholesterol. Regular ophthalmologic examinations are essential to evaluate the progression of diabetic retinopathy and to determine appropriate treatment strategies like laser therapy, anti-VEGF injections, or vitrectomy if necessary. Patient education on lifestyle modifications, including diet and exercise, is crucial for managing diabetes and preventing further complications.
In simple words: This code describes a type of diabetes (type 2) where high blood sugar has caused damage to the blood vessels in the back of the eye, leading to the growth of abnormal new blood vessels. However, the most sensitive part of the eye, the macula, is not yet swollen.
Type 2 diabetes mellitus with proliferative diabetic retinopathy (PDR) without macular edema refers to a condition where the body doesn't effectively produce or use insulin, resulting in high blood glucose levels. This leads to the growth of new blood vessels in the retina (PDR), but without swelling in the macula (the central part of the retina responsible for sharp vision).
Example 1: A 55-year-old patient with a long history of type 2 diabetes presents with blurred vision and floaters. Upon examination, neovascularization is observed in the retina, but there is no macular edema. The patient's HbA1c is 9.5%. This scenario is coded as E11.359., A 60-year-old with type 2 diabetes, managed with oral medications, complains of fluctuating vision. Fluorescein angiography reveals proliferative diabetic retinopathy without macular involvement. The diagnosis is E11.359., A patient with type 2 diabetes and existing mild non-proliferative diabetic retinopathy undergoes a routine eye exam. The ophthalmologist notes progression to proliferative retinopathy with neovascularization but without macular edema. The patient receives anti-VEGF injections. The code used is E11.359.
Diagnosis of type 2 diabetes; ophthalmologic examination findings confirming proliferative diabetic retinopathy (PDR); absence of macular edema; HbA1c levels; treatment details (e.g., medication, laser therapy).
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital