E09.3551

E09.3551: Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye

Billable / specific codeICD-10-CM

E09.3551 is a billable, specific ICD-10-CM code for drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye. It is valid for submission on a claim.

Check E09.3551 with the rest of the claim: free scrubber

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

Excludes1 inherited from the categories above E09.3551

A category’s note binds every code beneath it.

Written on E09: Drug or chemical induced diabetes mellitus

diabetes mellitus due to underlying condition (E08.-)
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 E09.3551

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

E08Diabetes mellitus due to underlying condition
E10Type 1 diabetes mellitus
E11Type 2 diabetes mellitus
E13Other specified diabetes mellitus

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

E09.3551 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.