2022 ICD-10-CM Code E10.3539

Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

Version 2021

Valid for Submission

ICD-10:E10.3539
Short Description:Type 1 diab w prolif diab rtnop with trctn dtch n-mcla, unsp
Long Description:Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye

Code Classification

  • Endocrine, nutritional and metabolic diseases (E00–E90)
    • Diabetes mellitus (E08-E13)
      • Type 1 diabetes mellitus (E10)

E10.3539 is a billable diagnosis code used to specify a medical diagnosis of type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye. The code E10.3539 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.

Unspecified diagnosis codes like E10.3539 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

The code E10.3539 is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Diabetes: Hemoglobin A1c (hba1c) Poor Control (>9%) , Diabetes: Eye Exam.

Coding Guidelines

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 - E13 as needed to identify all of the associated conditions that the patient has.

The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason type 1 diabetes mellitus is also referred to as juvenile diabetes.

Replacement Code

E103539 replaces the following previously assigned ICD-10 code(s):

Convert E10.3539 to ICD-9 Code

Quality Payment Program Measures

When code E10.3539 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.

Quality Measure Description Quality Domain Measure Type High Priority Submission Methods
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.Effective Clinical CareIntermediateoutcomeYESClaims, Electronichealthrecord, Cmswebinterface, Registry
Diabetes: Eye ExamPercentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy overlapping the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy overlapping the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period.Effective Clinical CareProcessNOClaims, Electronichealthrecord, Registry

Information for Patients


Diabetes Type 1

Diabetes means your blood glucose, or blood sugar, levels are too high. With type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth.

Type 1 diabetes happens most often in children and young adults but can appear at any age. Symptoms may include

A blood test can show if you have diabetes. If you do, you will need to take insulin for the rest of your life. A blood test called the A1C can check to see how well you are managing your diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


[Learn More in MedlinePlus]

Diabetic Eye Problems

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage your eyes. The most common problem is diabetic retinopathy. It is a leading cause of blindness in American adults.

Your retina is the light-sensitive tissue at the back of your eye. You need a healthy retina to see clearly. Diabetic retinopathy damages the tiny blood vessels inside your retina.

You may not notice it at first. Symptoms can include

Treatment often includes laser treatment or surgery, with follow-up care.

Two other eye problems can happen to people with diabetes. A cataract is a cloud over the lens of your eye. Surgery helps you see clearly again. Glaucoma happens when pressure builds up in the eye, damaging the main nerve. Eye drops or surgery can help.

If you have diabetes, you should have a complete eye exam every year. Finding and treating problems early may save your vision.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


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Retinal Detachment

The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. It provides the sharp, central vision needed for reading, driving, and seeing fine detail. A retinal detachment lifts or pulls the retina from its normal position. It can occur at any age, but it is more common in people over age 40. It affects men more than women and whites more than African Americans. A retinal detachment is also more likely to occur in people who

Symptoms include an increase in the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. It may also seem like there is a "curtain" over your field of vision.

A retinal detachment is a medical emergency. If not promptly treated, it can cause permanent vision loss. If you have any symptoms, see an eye care professional immediately. Treatment includes different types of surgery.

NIH: National Eye Institute


[Learn More in MedlinePlus]

Diabetic Eye Disease Learn about diabetes and eye disease; symptoms, warning signs, and treatments; and how you can prevent eye disease—or keep it from getting worse.
[Learn More in MedlinePlus]

Code History

  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018