E08.311 — Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
E08.311 is a billable, specific ICD-10-CM code for diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema. It is valid for submission on a claim.
Excludes1 inherited from the categories above E08.311
These are not written on E08.311, but they bind it: a note on a category applies to every code beneath it. Billing E08.311 with anything listed here is a denial.
Written on E08 — Diabetes mellitus due to underlying condition
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- postpancreatectomy diabetes mellitus (E13.-)
- postprocedural diabetes mellitus (E13.-)
- secondary diabetes mellitus NEC (E13.-)
- type 1 diabetes mellitus (E10.-)
- type 2 diabetes mellitus (E11.-)
Other codes that can never be billed with E08.311
These codes carry an Excludes1 note pointing at E08.311. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E08.311 alone.
Risk adjustment
E08.311 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 37 Diabetes with Chronic Complications0.166 RAF
- HCC 298 Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage0.336 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
E08.311 is named in 41 Medicare coverage policies — 40 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57069Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)not covered
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars
- A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars
How E08.311 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to E08.311.
- Diabetes, diabetic›due to underlying condition›with›retinopathy›with macular edema
Code history
E08.311 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share E08.31. If E08.311 is not quite right, the correct code is usually one of these.
Questions about E08.311
- Is E08.311 a billable ICD-10-CM code?
- Yes. E08.311 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E08.311 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).
- What cannot be coded together with E08.311?
- E08.311 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above E08.311 (E08) and apply to it just the same.