ICD Code E11.3513

ICD code E11.3513 is used to classify a diagnosis of Type 2 diabetes mellitus in a patient who also has proliferative diabetic retinopathy with macular edema affecting both eyes. This code is part of the ICD-10-CM system, which is utilized by healthcare providers to document and communicate specific health conditions for billing and statistical purposes. The code indicates a complex condition where diabetes has led to advanced eye disease, characterized by abnormal blood vessel growth in the retina and swelling in the macula, the central part of the retina responsible for sharp vision.

When using the ICD code for this specific condition, ensure that the following diagnostic criteria and symptoms are met:

1. Diagnosis of Type 2 Diabetes Mellitus: Confirm that the patient has been diagnosed with Type 2 diabetes mellitus, which is characterized by insulin resistance and relative insulin deficiency.

2. Presence of Proliferative Diabetic Retinopathy: Identify the presence of proliferative diabetic retinopathy, which involves the growth of new blood vessels on the retina and posterior surface of the vitreous. This condition is a progression from non-proliferative diabetic retinopathy.

3. Macular Edema: Confirm the presence of macular edema, which is the swelling or thickening of the macula due to fluid accumulation. This condition can significantly affect vision.

4. Bilateral Involvement: Ensure that the condition affects both eyes. Bilateral involvement is a critical component of this specific ICD code.

5. Clinical Evaluation and Imaging: Utilize clinical evaluation and imaging techniques such as fundus photography, optical coherence tomography (OCT), or fluorescein angiography to support the diagnosis and document the presence of the above conditions.

By ensuring these criteria are met, healthcare providers can accurately use the ICD code for documentation, billing, and treatment planning purposes.

For the ICD code E11.3513, which pertains to Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral, the relevant CPT codes that may be applicable for treatment include:

1. 67028 - Intravitreal injection of a pharmacologic agent (e.g., anti-VEGF).

2. 67210 - Destruction of localized lesion of retina (e.g., macular edema), one or more sessions; photocoagulation.

3. 67228 - Treatment of extensive or progressive retinopathy (e.g., diabetic retinopathy), photocoagulation.

4. 92134 - Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.

These CPT codes are commonly used in the management and treatment of conditions associated with diabetic retinopathy and macular edema. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment or procedure performed.

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