E10.3319 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
E10.3319 is a billable, specific ICD-10-CM code for type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye. It is valid for submission on a claim.
7th character "9" — unspecified eye
One of the following 7th characters is to be assigned to codes in subcategory E10.33 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E10.3319 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 37 Diabetes with Chronic Complications0.166 RAF
- 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
E10.3319 is named in 10 Medicare coverage policies — 10 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52464Glucose Monitor - Policy Article
- A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
- A52507External Infusion Pumps - Policy Article
- A56232Billing and Coding: Foot Care
Related codes at this level
Codes that share E10.331. If E10.3319 is not quite right, the correct code is usually one of these.
- E10.3311Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
- E10.3312Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
- E10.3313Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
Questions about E10.3319
- Is E10.3319 a billable ICD-10-CM code?
- Yes. E10.3319 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E10.3319 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).