E11.3212 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E11.3212 is a billable, specific ICD-10-CM code for type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye. It is valid for submission on a claim.
7th character "2" — left eye
One of the following 7th characters is to be assigned to codes in subcategory E11.32 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Excludes1 inherited from the categories above E11.3212
These are not written on E11.3212, but they bind it: a note on a category applies to every code beneath it. Billing E11.3212 with anything listed here is a denial.
Written on E11 — Type 2 diabetes mellitus
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- 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.-)
Other codes that can never be billed with E11.3212
These codes carry an Excludes1 note pointing at E11.3212. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E11.3212 alone.
Risk adjustment
E11.3212 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- 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
E11.3212 is named in 63 Medicare coverage policies — 62 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
There’s a guided path to this code
Not sure E11.3212 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.
The condition this code belongs to
Every code for the condition on one page, which one applies when, and the mistake coders make with it.
Code history
E11.3212 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 E11.321. If E11.3212 is not quite right, the correct code is usually one of these.
- E11.3211Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
- E11.3213Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
- E11.3219Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
Questions about E11.3212
- Is E11.3212 a billable ICD-10-CM code?
- Yes. E11.3212 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E11.3212 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 E11.3212?
- E11.3212 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 E11.3212 (E11) and apply to it just the same.