E11.3559 — Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
E11.3559 is a billable, specific ICD-10-CM code for type 2 diabetes mellitus with stable proliferative diabetic retinopathy, 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 E11.35 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E11.3559 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
E11.3559 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
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Related codes at this level
Codes that share E11.355. If E11.3559 is not quite right, the correct code is usually one of these.
Questions about E11.3559
- Is E11.3559 a billable ICD-10-CM code?
- Yes. E11.3559 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E11.3559 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).