ICD-10 Coding for Diabetes with Retinopathy(E11.319, E11.359)
Complete ICD-10-CM coding and documentation guide for Diabetes with Retinopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetes with Retinopathy
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema | Use when retinopathy is present but not specified as proliferative or nonproliferative, and no macular edema is documented. |
|
| E11.359 | Type 2 diabetes mellitus with proliferative diabetic retinopathy | Use when proliferative retinopathy is documented. |
|
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 diabetes with retinopathy
Essential facts and insights about Diabetes with Retinopathy
Primary ICD-10-CM Codes for diabetes with retinopathy
Decision Criteria
clinical Criteria
- Presence of retinopathy without macular edema
Applicable To
- Type 2 diabetes with retinopathy
Excludes
- Diabetes with macular edema
Clinical Validation Requirements
- Diagnosis of type 2 diabetes
- Retinopathy confirmed by fundus examination
Code-Specific Risks
- Risk of undercoding if retinopathy specifics are documented but not coded
Coding Notes
- Ensure documentation specifies the type of retinopathy to avoid unspecified coding.
E11.359 - Type 2 diabetes mellitus with proliferative diabetic retinopathy
Use when proliferative retinopathy is documented.
Applicable To
- Type 2 diabetes with proliferative retinopathy
Excludes
- Diabetes with macular edema
Clinical Validation Requirements
- Diagnosis of type 2 diabetes
- Proliferative retinopathy confirmed by fundus examination or fluorescein angiography
Coding Notes
Document the presence of neovascularization to support proliferative retinopathy coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Retinopathy
H35.0Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetes with Retinopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.319.
Impact
Clinical: Inaccurate clinical records, Regulatory: Non-compliance with coding guidelines, Financial: Potential for denied claims
Mitigation Strategy
Use templates that prompt for laterality, Educate providers on documentation requirements
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Increases risk of audit and non-compliance with coding guidelines., Data Quality: Results in poor data quality and inaccurate clinical reporting.
Mitigation Strategy
Always code to the highest level of specificity documented in the medical record.
Impact
High risk of audit if unspecified codes are used when specifics are documented.
Mitigation Strategy
Implement regular audits of documentation to ensure specificity.
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 Diabetes with Retinopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetes with Retinopathy
Use these documentation templates to ensure complete and accurate documentation for Diabetes with Retinopathy. These templates include all required elements for proper coding and billing.
Diabetic Retinopathy Evaluation
Specialty: OphthalmologyRequired Elements
- Type of diabetes
- Retinopathy stage
- Laterality
- Presence of macular edema
- Fundus examination findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Diabetes with Retinopathy? Ask your questions below.