E09.3511 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E09.3511 is a billable, specific ICD-10-CM code for drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye. It is valid for submission on a claim.
7th character "1" — right eye
One of the following 7th characters is to be assigned to codes in subcategory E09.35 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E09.3511 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
E09.3511 is named in 53 Medicare coverage policies — 52 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
Related codes at this level
Codes that share E09.351. If E09.3511 is not quite right, the correct code is usually one of these.
- E09.3512Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E09.3513Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
- E09.3519Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
Questions about E09.3511
- Is E09.3511 a billable ICD-10-CM code?
- Yes. E09.3511 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E09.3511 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).