E10.3599

E10.3599: Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

Billable / specific codeICD-10-CM

E10.3599 is a billable, specific ICD-10-CM code for type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye. It is valid for submission on a claim.

Check E10.3599 with the rest of the claim: free scrubber

7th character "9": unspecified eye

One of the following 7th characters is to be assigned to codes in subcategory E10.35 to designate laterality of the disease:

1: right eye
2: left eye
3: bilateral
9: unspecified eye

Excludes1 inherited from the categories above E10.3599

A category’s note binds every code beneath it.

Written on E10: Type 1 diabetes mellitus

diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
hyperglycemia NOS (R73.9)
neonatal diabetes mellitus (P70.2)
postpancreatectomy diabetes mellitus (E13.-)
postprocedural diabetes mellitus (E13.-)
secondary diabetes mellitus NEC (E13.-)
type 2 diabetes mellitus (E11.-)

Other codes that can never be billed with E10.3599

Their own Excludes1 notes name this code, so the conflict is not listed above.

E08Diabetes mellitus due to underlying condition
E09Drug or chemical induced diabetes mellitus
E11Type 2 diabetes mellitus
E13Other specified diabetes mellitus
Q45.3Other congenital malformations of pancreas and pancreatic duct

Risk adjustment

E10.3599 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

E10.3599 is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52464Glucose Monitor - Policy Article
A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
A52507External Infusion Pumps - Policy Article
A56232Billing and Coding: Foot Care

Code history

Unchanged in every release from FY2024 to FY2027.