E10.3213 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E10.3213 is a billable, specific ICD-10-CM code for type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral. It is valid for submission on a claim.
7th character "3" — bilateral
One of the following 7th characters is to be assigned to codes in subcategory E10.32 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Excludes1 inherited from the categories above E10.3213
These are not written on E10.3213, but they bind it: a note on a category applies to every code beneath it. Billing E10.3213 with anything listed here is a denial.
Written on E10 — Type 1 diabetes mellitus
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- hyperglycemia NOS (R73.9)
- neonatal diabetes mellitus (P70.2)
- postpancreatectomy diabetes mellitus (E13.-)
- postprocedural diabetes mellitus (E13.-)
- secondary diabetes mellitus NEC (E13.-)
- type 2 diabetes mellitus (E11.-)
Other codes that can never be billed with E10.3213
These codes carry an Excludes1 note pointing at E10.3213. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E10.3213 alone.
Risk adjustment
E10.3213 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 37 Diabetes with Chronic Complications0.166 RAF
- 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.
Medicare coverage
E10.3213 is named in 56 Medicare coverage policies — 55 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
E10.3213 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 E10.321. If E10.3213 is not quite right, the correct code is usually one of these.
- E10.3211Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E10.3212Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
- E10.3219Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
Questions about E10.3213
- Is E10.3213 a billable ICD-10-CM code?
- Yes. E10.3213 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E10.3213 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 E10.3213?
- E10.3213 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 E10.3213 (E10) and apply to it just the same.