E11.351 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
E11.351 is a non-billable header ICD-10-CM code for type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.
This code requires a 7th character
One of the following 7th characters is to be assigned to codes in subcategory E11.35 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E11.351 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.
How E11.351 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 E11.351.
- Diabetes, diabetic›with›retinopathy›proliferative›with›macular edema
- Diabetes, diabetic›type 2›with›retinopathy›proliferative›with›macular edema
There’s a guided path to this code
Not sure E11.351 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.
Code to one of these instead E11.351
4 child codes. Green means billable.
- E11.3511Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- E11.3512Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
- E11.3513Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
- E11.3519Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
Related codes at this level
Codes that share E11.35. If E11.351 is not quite right, the correct code is usually one of these.
- E11.352Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula
- E11.353Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula
- E11.354Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment
- E11.355Type 2 diabetes mellitus with stable proliferative diabetic retinopathy
- E11.359Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
Questions about E11.351
- Is E11.351 a billable ICD-10-CM code?
- No. E11.351 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does E11.351 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).