2021 ICD-10-CM Code E13.3411

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

Version 2021

Valid for Submission

E13.3411 is a billable diagnosis code used to specify a medical diagnosis of other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye. The code E13.3411 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions.

The code E13.3411 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.

ICD-10:E13.3411
Short Description:Oth diab with severe nonp rtnop with macular edema, r eye
Long Description:Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye

Code Classification

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.

Replacement Code

E133411 replaces the following previously assigned ICD-10 code(s):

Convert E13.3411 to ICD-9 Code

Quality Payment Program Measures

When code E13.3411 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

Also called: DM, Diabetes mellitus

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


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Diabetic Eye Problems

Also called: Diabetic retinopathy

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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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