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ICD-10 Coding for Diabetic Eye Exam(E10.3211, E11.359)

Complete ICD-10-CM coding and documentation guide for Diabetic Eye Exam. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Diabetic Retinal ExamDiabetic Ophthalmic Examination

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Related ICD-10 Code Ranges

Complete code families applicable to Diabetic Eye Exam

E10.3-E11.3Primary Range

Diabetes mellitus with ophthalmic complications

This range includes codes for diabetes with specific eye complications such as retinopathy and macular edema.

H40-H42

Glaucoma

Relevant for documenting glaucoma as a comorbidity in diabetic patients.

Z79.4

Long-term (current) use of insulin

Used to indicate insulin dependency in diabetic patients.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
E10.3211Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eyeUse when documenting Type 1 diabetes with mild NPDR and macular edema in the right eye.
  • OCT confirming macular edema
  • Dilated fundus exam findings
E11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edemaUse for Type 2 diabetes with proliferative retinopathy without macular edema.
  • Fluorescein angiography showing neovascularization

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for diabetic eye exam

Essential facts and insights about Diabetic Eye Exam

The ICD-10 code for a diabetic eye exam depends on the diabetes type and complications, such as E10.3211 for Type 1 diabetes with NPDR and macular edema.

Primary ICD-10-CM Codes for diabetic eye exam

E10.3211
Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
Billable Code

Decision Criteria

clinical Criteria

  • Presence of macular edema confirmed by OCT

documentation Criteria

  • Detailed description of NPDR severity and laterality

Applicable To

  • Mild NPDR with macular edema in right eye

Excludes

Clinical Validation Requirements

  • OCT confirming macular edema
  • Dilated fundus exam findings

Code-Specific Risks

  • Ensure laterality is correctly documented
  • Avoid unspecified codes

Coding Notes

  • Ensure documentation specifies the presence of macular edema and laterality.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of insulin

Z79.4
Use to indicate insulin use in diabetic patients.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema

E10.329
Use when macular edema is not present.

Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema

E11.359
Use when macular edema is present.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Diabetic Eye Exam to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E10.3211.

Impact

Clinical: Leads to incomplete patient records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.

Mitigation Strategy

Use templates that prompt for laterality., Regular training on documentation standards.

Impact

Reimbursement: May lead to claim denials or reduced payments., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts accuracy of patient records.

Mitigation Strategy

Always specify the type of diabetes and the presence of complications.

Impact

Using unspecified codes can trigger audits.

Mitigation Strategy

Always use the most specific code available.

Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.

Frequently Asked Questions

Common questions about ICD-10 coding for Diabetic Eye Exam, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Diabetic Eye Exam

Use these documentation templates to ensure complete and accurate documentation for Diabetic Eye Exam. These templates include all required elements for proper coding and billing.

Diabetic Eye Exam for Type 2 Diabetes

Specialty: Ophthalmology

Required Elements

  • Patient history
  • Visual acuity
  • Dilated fundus exam
  • OCT results

Example Documentation

62M with Type 2 DM x8 yrs, HbA1c 8.2%. BCVA 20/40 OD, 20/30 OS. Dilated exam: moderate NPDR with circinate hard exudates within 500μm fovea OU. OCT confirms central-involved ME OD. Plan: Anti-VEGF OD, repeat OCT in 4 wks.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Diabetic retinopathy present.
Good Documentation Example
Dilated fundus exam revealed microaneurysms, dot-blot hemorrhages, and clinically significant macular edema (CSME) in the right eye.
Explanation
The good example provides specific findings and laterality, which are necessary for accurate coding.

Need help with ICD-10 coding for Diabetic Eye Exam? Ask your questions below.

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