E11.319 — Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.319 is a billable, specific ICD-10-CM code for type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema. It is valid for submission on a claim.
Risk adjustment
E11.319 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 37 Diabetes with Chronic Complications0.166 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
E11.319 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
- 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
- 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 E11.319 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 E11.319.
- Diabetes, diabetic›with›retinopathy
- Diabetes, diabetic›type 2›with›retinopathy
There’s a guided path to this code
Not sure E11.319 is the right one? Answer a few questions about what the chart documents and we’ll walk you to the code that follows from it.
Related codes at this level
Codes that share E11.31. If E11.319 is not quite right, the correct code is usually one of these.
Questions about E11.319
- Is E11.319 a billable ICD-10-CM code?
- Yes. E11.319 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E11.319 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).