E11.3542 vs E11.3543

Summary

What is different?

Title wording.The titles share “Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment”; E11.3542 says “left eye” where E11.3543 says “bilateral”.

Registry fact

Can these codes be reported together?

One code for both sides.E11.3542 and E11.3543 name the same condition on one side and on both sides. When the condition is documented on both sides and the code set provides a bilateral code, the bilateral code is assigned rather than a code for each side (ICD-10-CM Official Guidelines, Section I.B.13).

MedCoder-derivedGuide: Laterality coding

Are there other coding relationships?

Yes.Same condition; one side or both sides. E11.3542 and E11.3543 name the same condition on one side and on both sides.

MedCoder-derivedGuide: Laterality coding

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Official guidance behind these answers

• Section I.B.13 — Laterality · applies to: Laterality

  Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. If the side is not identified in the medical record, assign the code for the unspecified side. When a patient has a bilateral condition and each side is treated during separate encounters, assign the "bilateral" code (as the condition still exists on both sides), including for the encounter to treat the first side. For the second encounter for treatment after one side has previously been treated and the condition no longer exists on that side, assign the appropriate unilateral code for the side where the condition still exists (e.g., cataract surgery performed on each eye in separate encounters). The bilateral code would not be assigned for the subsequent encounter, as the patient no longer has the condition in the previously-treated site. If the treatment on the first side did not completely resolve the condition, then the bilateral code would still be appropriate. When laterality is not documented by the patient’s provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting medical record documentation regarding the affected side, the patient’s provider should be queried for clarification. […]

  ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

No Excludes2, Code first and Code also note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.