E11.37X1 — Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
E11.37X1 is a billable, specific ICD-10-CM code for type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye. It is valid for submission on a claim.
7th character "1" — right eye
One of the following 7th characters is to be assigned to code E11.37 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E11.37X1 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
E11.37X1 is named in 50 Medicare coverage policies — 49 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
- A52464Glucose Monitor - Policy Article
- A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
- A52507External Infusion Pumps - Policy Article
There’s a guided path to this code
Not sure E11.37X1 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 E11.37. If E11.37X1 is not quite right, the correct code is usually one of these.
- E11.37X2Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
- E11.37X3Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
- E11.37X9Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
Questions about E11.37X1
- Is E11.37X1 a billable ICD-10-CM code?
- Yes. E11.37X1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E11.37X1 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).