E11.3399 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye
E11.3399 is a billable, specific ICD-10-CM code for type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye. It is valid for submission on a claim.
7th character "9" — unspecified eye
One of the following 7th characters is to be assigned to codes in subcategory E11.33 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E11.3399 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
E11.3399 is named in 17 Medicare coverage policies — 17 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52464Glucose Monitor - Policy Article
- A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
- A52507External Infusion Pumps - Policy Article
- A56232Billing and Coding: Foot Care
There’s a guided path to this code
Not sure E11.3399 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 E11.339. If E11.3399 is not quite right, the correct code is usually one of these.
- E11.3391Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye
- E11.3392Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye
- E11.3393Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
Questions about E11.3399
- Is E11.3399 a billable ICD-10-CM code?
- Yes. E11.3399 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E11.3399 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).