{"code":"E10.3513","type":"code","title":"Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral","codeAlso":[],"includes":["brittle diabetes (mellitus)","diabetes (mellitus) due to autoimmune process","diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction","idiopathic diabetes (mellitus)","juvenile onset diabetes (mellitus)","ketosis-prone diabetes (mellitus)"],"modern_v":"official26","codeFirst":[],"excludes1":["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.-)"],"excludes2":[],"isBillable":true,"fyEffectivity":{"fy2026":true,"fy2027":true,"billableFy2026":true,"billableFy2027":true},"sibling_codes":["E10","E10.1","E10.2","E10.21","E10.22","E10.3","E10.311","E10.319","E10.32","E10.321","E10.3211","E10.3212","E10.3213","E10.3219","E10.329","E10.3291","E10.3292","E10.3293","E10.3299","E10.33","E10.331","E10.3311","E10.3312","E10.3313","E10.3319","E10.339","E10.3391","E10.3392","E10.3393","E10.3399","E10.34","E10.341","E10.3411","E10.3412","E10.3413","E10.3419","E10.349","E10.3491","E10.3492","E10.3493","E10.3499","E10.351","E10.3511","E10.3512","E10.3519","E10.352","E10.3521","E10.3522","E10.3523","E10.3529","E10.353","E10.3531","E10.3532","E10.3533","E10.3539","E10.354","E10.3541","E10.3542","E10.3543","E10.3549","E10.355","E10.3551","E10.3552","E10.3553","E10.3559","E10.359","E10.3591","E10.3592","E10.3593","E10.3599","E10.37X1","E10.37X2","E10.37X3","E10.37X9","E10.4","E10.40","E10.41","E10.42","E10.43","E10.44","E10.49","E10.5","E10.51","E10.52","E10.59","E10.6","E10.61","E10.610","E10.618","E10.62","E10.620","E10.621"],"inclusionTerms":[],"sibling_titles":{"code":"E10.621","title":"Type 1 diabetes mellitus with foot ulcer","isBillable":true},"useAdditionalCode":[],"clinicalDefinition":"Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral is a billable ICD-10-CM diagnosis code (E10.3513). Includes: brittle diabetes (mellitus); diabetes (mellitus) due to autoimmune process; diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction; idiopathic diabetes (mellitus); juvenile onset diabetes (mellitus); ketosis-prone diabetes (mellitus). Excludes1 (not coded here): diabetes mellitus due to underlying condition (E08.","officialDefinition":"Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral is a billable ICD-10-CM diagnosis code (E10.3513). Includes: brittle diabetes (mellitus); diabetes (mellitus) due to autoimmune process; diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction; idiopathic diabetes (mellitus); juvenile onset diabetes (mellitus); ketosis-prone diabetes (mellitus). Excludes1 (not coded here): 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.-). 7th character: One of the following 7th characters is to be assigned to codes in subcategory E10.35 to designate laterality of the disease:.","seventhCharacterInstructions":["One of the following 7th characters is to be assigned to codes in subcategory E10.35 to designate laterality of the disease:"],"workflowProtocols":[],"guidelines":{"whenToUse":[],"whenNotToUse":[],"commonBillingMistakes":[],"codeComparisons":[],"documentationChecklist":[]},"domainLandscape":{"summary":"Primary diagnostic domain and clinical landscape evaluation.","keyCategories":[],"diagnosticContinuum":"Progression continuum from acute presentation to resolution."},"children":[],"hierarchy":[],"relatedCodes":[],"relevantCPTCodes":[],"documentationTips":[],"caseStudies":[],"description":"","overview":"","noteProvenance":{"diabetes mellitus due to underlying condition (E08.-)":"E10","drug or chemical induced diabetes mellitus (E09.-)":"E10","gestational diabetes (O24.4-)":"E10","hyperglycemia NOS (R73.9)":"E10","neonatal diabetes mellitus (P70.2)":"E10","postpancreatectomy diabetes mellitus (E13.-)":"E10","postprocedural diabetes mellitus (E13.-)":"E10","secondary diabetes mellitus NEC (E13.-)":"E10","type 2 diabetes mellitus (E11.-)":"E10","brittle diabetes (mellitus)":"E10","diabetes (mellitus) due to autoimmune process":"E10","diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction":"E10","idiopathic diabetes (mellitus)":"E10","juvenile onset diabetes (mellitus)":"E10","ketosis-prone diabetes (mellitus)":"E10"},"hcc":{"mapped":true,"model":"CMS-HCC V28","paymentYear":"2026","categories":[{"hcc":"298","label":"Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage","family":"","suppresses":[]},{"hcc":"37","label":"Diabetes with Chronic Complications","family":"Diabetes","suppresses":[{"hcc":"38","label":"Diabetes with Glycemic, Unspecified, or No Complications"}]}],"otherModels":[{"model":"CMS-HCC V22","hcc":"122"},{"model":"CMS-HCC V22","hcc":"18"},{"model":"RxHCC V08","hcc":"30"}]}}