E08.3542

E08.3542: Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

Billable / specific codeICD-10-CM

E08.3542 is a billable, specific ICD-10-CM code for diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye. It is valid for submission on a claim.

Check E08.3542 with the rest of the claim: free scrubber

7th character "2": left eye

One of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:

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

Excludes1 inherited from the categories above E08.3542

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 E08.3542

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

E08.3542 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

E08.3542 is named in 46 Medicare coverage policies: 46 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

Code history

Unchanged in every release from FY2024 to FY2027.