E13.3539 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
E13.3539 is a billable, specific ICD-10-CM code for other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, 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 E13.35 to designate laterality of the disease:
- 1
- right eye
- 2
- left eye
- 3
- bilateral
- 9
- unspecified eye
Risk adjustment
E13.3539 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
E13.3539 is named in 12 Medicare coverage policies — 12 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
Related codes at this level
Codes that share E13.353. If E13.3539 is not quite right, the correct code is usually one of these.
- E13.3531Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye
- E13.3532Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
- E13.3533Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
Questions about E13.3539
- Is E13.3539 a billable ICD-10-CM code?
- Yes. E13.3539 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does E13.3539 sit in the tabular list?
- Endocrine, nutritional and metabolic diseases (E00-E89), in the block Diabetes mellitus (E08-E13).