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ICD-10/E10.3522

E10.3522 ICD-10-CM Code: Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)
  • MS-DRG 010 — PANCREAS TRANSPLANT (MDC PRE)
  • MS-DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)
  • MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
  • MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
  • HCC 37 — Diabetes with Chronic Complications (supersedes HCC 38)

Other models: CMS-HCC V22 HCC 122 · CMS-HCC V22 HCC 18 · RxHCC V08 HCC 30

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Official Registry Overview & Definition

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye is a billable ICD-10-CM diagnosis code (E10.3522).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E10.3522 in the official ICD-10-CM tabular list.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • 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

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
    FY2017 changes

Verify Before Coding

  • Billable — reportable as written.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of E10.3522 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • E00-E89 — Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89) (E00-E89) [Hierarchy]
  • E08-E13 — Diabetes mellitus [Hierarchy]

Referenced by Excludes1 notes

  • E08 — Diabetes mellitus due to underlying condition [Excludes1](via E10.-): “type 1 diabetes mellitus (E10.-)” · check together
  • E09 — Drug or chemical induced diabetes mellitus [Excludes1](via E10.-): “type 1 diabetes mellitus (E10.-)” · check together
  • E11 — Type 2 diabetes mellitus [Excludes1](via E10.-): “type 1 diabetes mellitus (E10.-)” · check together
  • E13 — Other specified diabetes mellitus [Excludes1](via E10.-): “diabetes (mellitus) due to autoimmune process (E10.-)” · check together
  • H36 — Retinal disorders in diseases classified elsewhere [Excludes1](via E10.3.-): “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)” · check together
  • Q45.3 — Other congenital malformations of pancreas and pancreatic duct [Excludes1](via E10.-): “congenital diabetes mellitus (E10.-)” · check together

Clinical classification (CCSR)

  • END003 — Diabetes mellitus with complication [CCSR]
  • END004 — Diabetes mellitus, Type 1 [CCSR]
  • EYE005 — Retinal and vitreous conditions [CCSR]

Risk adjustment (CMS-HCC)

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]
  • HCC 37 — Diabetes with Chronic Complications [CMS-HCC]: “Diabetes with Chronic Complications — supersedes HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications)”

Potential MS-DRG

  • DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)”
  • DRG 010 — PANCREAS TRANSPLANT [MS-DRG]: “PANCREAS TRANSPLANT (MDC PRE)”
  • DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)”
  • DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT [MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”
  • DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC [MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”

MDC crossing · procedures (1353)

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 02 — Diseases and Disorders of the Eye [MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 02HA0QZ — Insertion of Implantable Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA0RZ — Insertion of Short-term External Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Short-term External Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA3QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA4QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02RA0LZ — Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach [Same-MDC procedure]: “Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • and 1348 more

Nearest codes (40)

  • E10 — Type 1 diabetes mellitus [Sibling]
  • E10.3399 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye [Sibling]
  • E10.34 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy [Sibling]
  • E10.341 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema [Sibling]
  • E10.3411 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye [Sibling]
  • E10.3412 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye [Sibling]
  • E10.3413 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral [Sibling]
  • E10.3419 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END004 — Diabetes mellitus, Type 1; EYE005 — Retinal and vitreous conditions.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 5 MS-DRGs: DRG 008 (MDC PRE), DRG 010 (MDC PRE), DRG 019 (MDC PRE), DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name E10.3522 or its code family.

6 Excludes1 notes across 3 chapters: E08 (via E10.-), E09 (via E10.-), E11 (via E10.-), E13 (via E10.-), H36 (via E10.3.-), Q45.3 (via E10.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does E10.3522 require a 7th character?

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E10.3522 in its code family, with their registry titles.

  • E10.3512 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
  • E10.3513 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
  • E10.3519 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
  • E10.352 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula
  • E10.3521 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
  • E10.3523 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
  • E10.3529 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye
  • E10.353 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula
  • E10.3531 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
  • E10.3532 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye

View all codes in the E10 family