2025 ICD-10-CM code E13.311
A specific type of diabetes mellitus accompanied by retinopathy with macular edema, the cause of which is not further specified.
Medical necessity for services related to E13.311 should be supported by documentation of the diabetic condition, the presence and severity of retinopathy and macular edema, and the impact on the patient's vision and quality of life.
Diagnosis and management of this condition falls under the purview of endocrinologists, ophthalmologists, and primary care physicians.They work collaboratively to control blood sugar levels, optimize eye health, and mitigate further complications.
In simple words: This code signifies a unique form of diabetes affecting the eyes, causing blurry vision due to swelling in the central part of the retina.It differs from Type 1 and Type 2 diabetes and requires specific treatment and management.
Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema refers to a form of diabetes not classified elsewhere, accompanied by diabetic retinopathy involving swelling in the macula of the eye.
Example 1: A patient with post-pancreatectomy diabetes develops blurred vision and is diagnosed with macular edema. The provider uses E13.311 as there is no other specific code for the retinopathy, A patient with diabetes due to a genetic defect in insulin action presents with diabetic retinopathy and macular edema. Since the diabetes type isn't Type 1 or Type 2, E13.311 is used. , A patient with a history of secondary diabetes mellitus, now controlled with oral medication, is found to have diabetic retinopathy and macular edema during an eye exam. E13.311 is applied.
Documentation should include the type of diabetes, details of the retinopathy and macular edema (including laterality if specified), medical history, examination findings, A1c levels, and treatment plan.
** This code is distinct from codes for Type 1 (E10.-) or Type 2 (E11.-) diabetes with retinopathy. It is crucial to accurately document the specific type of diabetes and the presence of macular edema to ensure appropriate coding and care.
- Specialties:Endocrinology, Ophthalmology, Internal Medicine, Family Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital