Is E09.3551 a billable ICD-10-CM code?

Yes. E09.3551 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does E09.3551 sit in the tabular list?

Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).

What cannot be coded together with E09.3551?

E09.3551 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above E09.3551 (E09) and apply to it just the same.

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.

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

These are not written on E09.3551, but they bind it: a note on a category applies to every code beneath it. Billing E09.3551 with anything listed here is a denial.

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

These codes carry an Excludes1 note pointing at E09.3551. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E09.3551 alone.

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

Risk adjustment

E09.3551 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

E09.3551 is named in 50 Medicare coverage policies — 49 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, Aflibercept and biosimilars
A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars

Code history

E09.3551 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share E09.355. If E09.3551 is not quite right, the correct code is usually one of these.

Questions about E09.3551

Is E09.3551 a billable ICD-10-CM code?: Yes. E09.3551 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does E09.3551 sit in the tabular list?: Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).
What cannot be coded together with E09.3551?: E09.3551 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above E09.3551 (E09) and apply to it just the same.