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Home/Diagnosis/ICD-10 Coding for Retinopathy

ICD-10 Coding for Retinopathy

E10.311
E11.359

Complete ICD-10-CM coding and documentation guide for icd-10 coding for retinopathy includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Diabetic Retinopathy
Hypertensive Retinopathy
Retinal Disease
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Key Information: ICD-10 Coding for Retinopathy

Essential facts and insights about ICD-10 Coding for Retinopathy

Use ICD-10 code E10.311 for type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema

Billable Code
E10.311
Billable

Diagnostic Criteria

clinical:
  • • Presence of macular edema confirmed by OCT.
documentation:
  • • Type 1 diabetes and retinopathy stage must be specified.

Applicable To

  • • Type 1 diabetes with retinopathy and macular edema

Important Notes

  • • Ensure diabetes type and presence of macular edema are clearly documented.

Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema

Non-Billable
E11.359
Non-Billable

Diagnostic Criteria

clinical:
  • • FFA showing neovascularization
  • • Absence of macular edema on OCT

Applicable To

  • • Type 2 diabetes with proliferative retinopathy

Important Notes

  • • Ensure documentation specifies absence of macular edema.
Ancillary Codes

Additional codes that may be used with this diagnosis

H35.06

Cystoid macular edema

Use when cystoid macular edema requires separate intervention.

Z79.4

Long-term (current) use of insulin

Use for insulin-dependent Type 2 diabetes patients.

Frequently Asked Questions

What is the ICD-10 code for diabetic retinopathy?

The ICD-10 code for diabetic retinopathy varies based on type and complications, such as E10.311 for type 1 diabetes with retinopathy and macular edema.

How do you code hypertensive retinopathy?

Hypertensive retinopathy is coded with H35.0- for retinopathy and I10-I15 for hypertension, sequenced based on the primary reason for the encounter.

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