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E10.359 ICD-10-CM Code: Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Official Registry Overview & Definition

Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E10.359). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E10.359 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).

Frequently Compared Codes

The official Excludes notes on E10.359 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

Verify Before Coding

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 E10.359 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

Referenced by Excludes2 notes

  • H35 — Other retinal disorders [Excludes2]: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)” · check together

Clinical classification (CCSR)

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

Index entries

  • Diabetes, diabetic (mellitus) (sugar), type 1, with, retinopathy, proliferative[Index term]

Nearest codes (40)

  • E10 — Type 1 diabetes mellitus [Sibling]
  • E10.352 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula [Sibling]
  • E10.3521 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye [Sibling]
  • E10.3522 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye [Sibling]
  • E10.3523 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral [Sibling]
  • E10.3529 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye [Sibling]
  • E10.353 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula [Sibling]
  • E10.3531 — Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye [Sibling]
  • and 32 more

Change history

  • FY2017 — Became a non-billable header [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.

Official ICD-10-CM tabular notes on other codes that name E10.359 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.-).

1 Excludes2 notes: H35.

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E10.359 be billed directly?

No. E10.359 (Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does E10.359 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 E10.359 in its code family, with their registry titles.

  • E10.355 — Type 1 diabetes mellitus with stable proliferative diabetic retinopathy
  • E10.3551 — Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
  • E10.3552 — Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
  • E10.3553 — Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
  • E10.3559 — Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
  • E10.3591 — Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
  • E10.3592 — Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
  • E10.3593 — Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
  • E10.3599 — Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
  • E10.36 — Type 1 diabetes mellitus with diabetic cataract

View all codes in the E10 family

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Diabetes, diabetic (mellitus) (sugar), type 1, with, retinopathy, proliferative