E08.3542 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
E08.3542 is a billable, specific ICD-10-CM code for diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye. It is valid for submission on a claim.
7th character "2" — left eye
One of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E08.3542 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 37 Diabetes with Chronic Complications0.166 RAF
- HCC 298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage0.336 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
E08.3542 is named in 50 Medicare coverage policies — 49 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57069Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)not covered
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52451Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf
- A52451Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf
Related codes at this level
Codes that share E08.354. If E08.3542 is not quite right, the correct code is usually one of these.
- E08.3541Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
- E08.3543Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
- E08.3549Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
Questions about E08.3542
- Is E08.3542 a billable ICD-10-CM code?
- Yes. E08.3542 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E08.3542 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).