E08.3319

E08.3319: Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

Billable / specific codeICD-10-CM

E08.3319 is a billable, specific ICD-10-CM code for diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye. It is valid for submission on a claim.

Check E08.3319 with the rest of the claim: free scrubber

7th character "9": unspecified eye

One of the following 7th characters is to be assigned to codes in subcategory E08.33 to designate laterality of the disease:

1: right eye
2: left eye
3: bilateral
9: unspecified eye

Excludes1 inherited from the categories above E08.3319

A category’s note binds every code beneath it.

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 E08.3319

Their own Excludes1 notes name this code, so the conflict is not listed above.

E09Drug or chemical induced diabetes mellitus
E10Type 1 diabetes mellitus
E11Type 2 diabetes mellitus
E13Other specified diabetes mellitus

Risk adjustment

E08.3319 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

E08.3319 is named in 7 Medicare coverage policies: 7 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52464Glucose Monitor - Policy Article
A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
A52507External Infusion Pumps - Policy Article
A56232Billing and Coding: Foot Care

Code history

Unchanged in every release from FY2024 to FY2027.