ICD-10: E11.352

ICD-10 code E11.352 refers to a specific condition within the broader category of Type 2 diabetes mellitus. This code is used to classify patients who have Type 2 diabetes and are experiencing proliferative diabetic retinopathy (PDR) with a traction retinal detachment that involves the macula. Below is a detailed clinical description and relevant information regarding this condition.

Overview of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency. It is often associated with obesity, sedentary lifestyle, and genetic predisposition. The condition can lead to various complications, including cardiovascular disease, neuropathy, nephropathy, and retinopathy, which is a significant concern for diabetic patients.

Proliferative Diabetic Retinopathy (PDR)

Proliferative diabetic retinopathy is an advanced stage of diabetic retinopathy, where new blood vessels (neovascularization) grow on the retina and/or optic disc due to ischemia (lack of blood flow). This abnormal growth can lead to serious complications, including:

• Vitreous Hemorrhage: Bleeding into the vitreous cavity, which can cause sudden vision loss.
• Traction Retinal Detachment: The formation of scar tissue that pulls on the retina, potentially leading to detachment.

Traction Retinal Detachment Involving the Macula

In the context of PDR, traction retinal detachment occurs when the newly formed blood vessels and associated scar tissue pull the retina away from its normal position. When this detachment involves the macula, the central part of the retina responsible for sharp vision, it can significantly impair visual acuity. Symptoms may include:

• Blurred or distorted vision
• Dark spots or floaters in the field of vision
• Sudden loss of vision

Clinical Implications of E11.352

The designation of E11.352 indicates that the patient has Type 2 diabetes with a specific complication of proliferative diabetic retinopathy and traction retinal detachment involving the macula. This classification is crucial for several reasons:

1. Treatment Planning: Understanding the severity of the retinopathy helps healthcare providers determine the appropriate interventions, which may include laser therapy, anti-VEGF injections (such as Ranibizumab or Aflibercept), or surgical options like vitrectomy.

2. Monitoring and Management: Patients with this diagnosis require close monitoring for progression of the disease and management of blood glucose levels to prevent further complications.

3. Insurance and Billing: Accurate coding is essential for reimbursement and insurance purposes, ensuring that patients receive the necessary care without undue financial burden.

Conclusion

ICD-10 code E11.352 encapsulates a critical aspect of diabetic care, highlighting the intersection of diabetes management and ophthalmic health. Proliferative diabetic retinopathy with traction retinal detachment involving the macula represents a severe complication that necessitates prompt and effective treatment to preserve vision and improve patient outcomes. Regular eye examinations and effective diabetes management are vital in preventing the onset and progression of these complications.

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and relative insulin deficiency, leading to elevated blood glucose levels. One of the serious complications of diabetes is diabetic retinopathy, which can progress to proliferative diabetic retinopathy (PDR). The ICD-10 code E11.352 specifically refers to T2DM with proliferative diabetic retinopathy that includes traction retinal detachment involving the macula. This condition has significant clinical implications and requires careful management.

Clinical Presentation

Overview of Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy is the advanced stage of diabetic retinopathy, characterized by the growth of new blood vessels (neovascularization) on the retina and/or optic disc. These new vessels are fragile and can lead to bleeding, scarring, and retinal detachment, particularly traction retinal detachment, which occurs when scar tissue pulls on the retina.

Signs and Symptoms

Patients with E11.352 may present with a variety of signs and symptoms, including:

• Visual Disturbances: Patients often report blurred vision, floaters, or sudden vision loss. The involvement of the macula can lead to significant central vision impairment.
• Retinal Hemorrhages: Fundoscopic examination may reveal dot-and-blot hemorrhages, flame-shaped hemorrhages, and cotton wool spots.
• Neovascularization: The presence of new, abnormal blood vessels can be observed on the retina or optic disc during an eye examination.
• Traction Retinal Detachment: This may be indicated by a change in the appearance of the retina, with possible folds or a wrinkled appearance, particularly in the macular area.

Patient Characteristics

Patients with E11.352 typically share certain characteristics:

• Diabetes Duration: Individuals often have a long history of poorly controlled diabetes, which increases the risk of developing diabetic retinopathy.
• Age: Most patients are middle-aged or older, as the risk of diabetic complications increases with age.
• Comorbidities: Many patients may have other comorbid conditions such as hypertension, hyperlipidemia, or cardiovascular disease, which can exacerbate diabetic complications.
• Ethnicity: Certain ethnic groups, including African Americans, Hispanics, and Native Americans, are at higher risk for developing diabetes and its complications.

Risk Factors

Several risk factors contribute to the development of proliferative diabetic retinopathy and traction retinal detachment:

• Poor Glycemic Control: Chronic hyperglycemia is a significant risk factor for the progression of diabetic retinopathy.
• Hypertension: Elevated blood pressure can worsen retinal damage and increase the risk of complications.
• Dyslipidemia: Abnormal lipid levels can contribute to the progression of diabetic retinopathy.
• Smoking: Tobacco use is associated with an increased risk of diabetic complications, including retinopathy.

Conclusion

The clinical presentation of E11.352, or Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, is characterized by significant visual impairment and specific ocular findings. Early detection and management are crucial to prevent further vision loss. Regular eye examinations and tight glycemic control are essential components of care for patients with diabetes to mitigate the risk of developing such complications.

ICD-10 code E11.352 refers specifically to Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula. This condition is a serious complication of diabetes that affects the eyes, particularly the retina. Below are alternative names and related terms that can be associated with this specific ICD-10 code.

Alternative Names

1. Proliferative Diabetic Retinopathy (PDR): This term describes the advanced stage of diabetic retinopathy where new blood vessels grow on the retina, which can lead to serious vision problems.

2. Traction Retinal Detachment: This refers to a type of retinal detachment caused by the pulling (traction) of the retina due to scar tissue, which is often a consequence of proliferative diabetic retinopathy.

3. Diabetic Maculopathy: While this term generally refers to any diabetic damage to the macula, it can be used in the context of proliferative changes affecting the macula.

4. Diabetic Retinopathy with Macular Involvement: This phrase emphasizes the involvement of the macula in the context of diabetic retinopathy.

5. Type 2 Diabetes with Retinal Complications: A broader term that encompasses various retinal issues arising from Type 2 diabetes, including proliferative diabetic retinopathy.

Related Terms

1. ICD-10 Codes: Other related ICD-10 codes include:
   - E11.359: Type 2 diabetes mellitus with proliferative diabetic retinopathy, unspecified.
   - E11.351: Type 2 diabetes mellitus with proliferative diabetic retinopathy with vitreous hemorrhage.

2. Diabetic Eye Disease: A general term that includes all eye-related complications due to diabetes, including diabetic retinopathy.

3. Vision Loss: A potential outcome of untreated proliferative diabetic retinopathy, highlighting the importance of early detection and management.

4. Retinal Vascular Disease: This term encompasses various conditions affecting the blood vessels in the retina, including those caused by diabetes.

5. Macular Edema: While not directly synonymous with E11.352, macular edema can occur alongside proliferative diabetic retinopathy and is a significant concern for vision.

Conclusion

Understanding the alternative names and related terms for ICD-10 code E11.352 is crucial for healthcare professionals involved in the diagnosis and treatment of diabetic eye diseases. These terms help in accurately communicating the condition and its implications for patient care. Proper coding and documentation are essential for effective management and treatment planning for patients with Type 2 diabetes and its complications.

The diagnosis of ICD-10 code E11.352, which refers to Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, involves specific clinical criteria and diagnostic procedures. Understanding these criteria is essential for accurate coding and effective patient management.

Overview of Proliferative Diabetic Retinopathy (PDR)

Proliferative diabetic retinopathy is a severe form of diabetic eye disease characterized by the growth of new blood vessels (neovascularization) in the retina, which can lead to complications such as retinal detachment. The presence of traction retinal detachment indicates that these new vessels are pulling on the retina, potentially affecting the macula, the area responsible for central vision.

Diagnostic Criteria

1. Clinical History and Symptoms

• Diabetes Diagnosis: The patient must have a confirmed diagnosis of Type 2 diabetes mellitus (E11).
• Symptoms: Patients may report vision changes, such as blurred vision, floaters, or sudden vision loss, which can indicate complications from diabetic retinopathy.

2. Ophthalmic Examination

• Fundoscopic Examination: A thorough eye examination is crucial. The presence of neovascularization, retinal hemorrhages, and exudates can indicate proliferative diabetic retinopathy.
• Optical Coherence Tomography (OCT): This imaging technique helps assess the macula's condition and can reveal the presence of traction retinal detachment.

3. Retinal Imaging

• Fluorescein Angiography: This test involves injecting a dye into the bloodstream to visualize the blood vessels in the retina. It can help identify areas of neovascularization and assess the extent of retinal damage.
• Ultrasound: In cases of suspected retinal detachment, ultrasound can be used to confirm the presence and extent of the detachment, particularly if the view of the retina is obscured.

4. Classification of Diabetic Retinopathy

• Proliferative Diabetic Retinopathy: The diagnosis of PDR is made when there is evidence of neovascularization on the retina or optic disc, along with any associated complications such as traction retinal detachment.
• Traction Retinal Detachment: This specific complication occurs when the new blood vessels pull on the retina, leading to detachment, particularly involving the macula, which is critical for central vision.

Documentation Requirements

For accurate coding under E11.352, the following documentation is essential:
- Diagnosis Confirmation: Clear documentation of the Type 2 diabetes diagnosis and the specific complications related to diabetic retinopathy.
- Details of Ophthalmic Findings: Comprehensive notes on the findings from the eye examination, imaging studies, and any treatments administered.
- Follow-Up Plans: Documentation of any planned interventions, such as laser treatment or surgery, to address the retinal detachment.

Conclusion

The diagnosis of ICD-10 code E11.352 requires a combination of clinical history, thorough ophthalmic examination, and appropriate imaging studies to confirm the presence of proliferative diabetic retinopathy with traction retinal detachment involving the macula. Accurate documentation and coding are crucial for effective patient management and treatment planning, ensuring that patients receive the necessary care for their diabetic eye disease.

Proliferative diabetic retinopathy (PDR) with traction retinal detachment involving the macula, classified under ICD-10 code E11.352, represents a severe complication of diabetes mellitus. This condition can lead to significant vision loss if not treated promptly and effectively. Below, we explore the standard treatment approaches for this condition, focusing on both medical and surgical interventions.

Understanding Proliferative Diabetic Retinopathy

Proliferative diabetic retinopathy is characterized by the growth of new blood vessels (neovascularization) in the retina, which can lead to complications such as vitreous hemorrhage and retinal detachment. When traction retinal detachment occurs, particularly involving the macula, it poses a serious risk to central vision, necessitating immediate intervention.

Standard Treatment Approaches

1. Medical Management

While medical management alone may not resolve PDR with traction retinal detachment, it plays a crucial role in controlling diabetes and preventing further complications:

• Glycemic Control: Maintaining optimal blood glucose levels is essential. This may involve lifestyle modifications, oral hypoglycemic agents, or insulin therapy to manage Type 2 diabetes effectively[1][2].
• Blood Pressure and Lipid Management: Controlling hypertension and dyslipidemia is also critical, as these factors can exacerbate diabetic retinopathy[3].

2. Laser Therapy

• Panretinal Photocoagulation (PRP): This is a common treatment for PDR. PRP involves using a laser to create small burns in the peripheral retina, which helps to reduce neovascularization and stabilize the condition. It is particularly effective in preventing further vision loss but may not directly address traction retinal detachment[4][5].

3. Surgical Interventions

When traction retinal detachment is present, surgical intervention is often necessary:

• Vitrectomy: This is the primary surgical procedure for addressing traction retinal detachment. During vitrectomy, the vitreous gel is removed to relieve traction on the retina. The surgeon may also perform membrane peeling to remove any epiretinal membranes contributing to the traction[6][7].
• Retinal Reattachment Techniques: After vitrectomy, techniques such as scleral buckling or gas tamponade may be employed to reattach the retina. These methods help to stabilize the retina and restore its normal position[8].

4. Anti-VEGF Therapy

• Intravitreal Injections: Anti-vascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab or aflibercept, may be used to reduce neovascularization and improve outcomes in patients with PDR. These injections can be administered before or after surgical intervention to enhance the effectiveness of treatment[9][10].

5. Follow-Up and Monitoring

Post-treatment, regular follow-up is essential to monitor for any recurrence of retinal detachment or progression of diabetic retinopathy. Patients should have comprehensive eye exams, including optical coherence tomography (OCT) and fundus photography, to assess the retina's condition and ensure timely intervention if needed[11].

Conclusion

The management of Type 2 diabetes mellitus with proliferative diabetic retinopathy and traction retinal detachment is multifaceted, involving a combination of medical management, laser therapy, and surgical intervention. Early detection and treatment are crucial to preserving vision and preventing further complications. Patients should work closely with their healthcare providers to develop a comprehensive treatment plan tailored to their specific needs and circumstances. Regular monitoring and adherence to diabetes management strategies are vital for long-term success in managing this serious condition.

References

1. 2025 ICD-10-CM Diagnosis Code E11.352 - The Web's Free 2023 ICD-10-CM.
2. ICD-10 Code for Type 2 diabetes mellitus with proliferative diabetic retinopathy.
3. Common Diabetes-related Eye Diseases & Their ICD-10 Codes.
4. ICD-10-CM Code for Type 2 diabetes mellitus E11 - AAPC.
5. Diabetes mellitus - ICD-10 Codes- Codify by AAPC.
6. Billing and Coding: Ophthalmology: Posterior Segment.
7. Clinical Policy: Electroretinography.
8. Billing and Coding: Electroretinography (ERG) (A57677).
9. Genetically-guided algorithm development and sample.
10. Billing and Coding: Vascular Endothelial Growth Factor.
11. Billing and Coding: Electroretinography Clinical Policy.