Is E11.359 a billable ICD-10-CM code?

No. E11.359 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does E11.359 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 E11.359?

E11.359 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 E11.359 (E11) and apply to it just the same.

E11.359

E11.359 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema

Non-billable headerICD-10-CM

E11.359 is a non-billable header ICD-10-CM code for type 2 diabetes mellitus with proliferative diabetic retinopathy without 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

Excludes1 inherited from the categories above E11.359

These are not written on E11.359, but they bind it: a note on a category applies to every code beneath it. Billing E11.359 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 E11.359

These codes carry an Excludes1 note pointing at E11.359. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E11.359 alone.

E10Type 1 diabetes mellitus
E09Drug or chemical induced diabetes mellitus
E08Diabetes mellitus due to underlying condition

Risk adjustment

E11.359 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 E11.359 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 E11.359.

Diabetes, diabetic›with›retinopathy›proliferative
Diabetes, diabetic›type 2›with›retinopathy›proliferative

There’s a guided path to this code

Not sure E11.359 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.

Type 2 diabetes: chart note to code

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.

Type 2 diabetes ICD-10 codes

Code history

E11.359 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead E11.359

4 child codes. Green means billable.

Related codes at this level

Codes that share E11.35. If E11.359 is not quite right, the correct code is usually one of these.

Questions about E11.359

Is E11.359 a billable ICD-10-CM code?: No. E11.359 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does E11.359 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 E11.359?: E11.359 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 E11.359 (E11) and apply to it just the same.