E09.311 — Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema
E09.311 is a billable, specific ICD-10-CM code for drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema. It is valid for submission on a claim.
Risk adjustment
E09.311 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
E09.311 is named in 39 Medicare coverage policies — 38 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 and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf
- A52451Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf
How E09.311 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 E09.311.
- Diabetes, diabetic›due to drug or chemical›with›retinopathy›with macular edema
Related codes at this level
Codes that share E09.31. If E09.311 is not quite right, the correct code is usually one of these.
Questions about E09.311
- Is E09.311 a billable ICD-10-CM code?
- Yes. E09.311 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E09.311 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).