E08.311: Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema

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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

E08.311 is named in 37 Medicare coverage policies: 36 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A57069Billing and Coding: Ophthalmic Angiography (Fluorescein and Indocyanine Green)not covered
• A52370Billing and Coding: Bevacizumab and biosimilars
• A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars
• A52464Glucose Monitor - Policy Article