Is E13.3541 a billable ICD-10-CM code?

Yes. E13.3541 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does E13.3541 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 E13.3541?

E13.3541 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 E13.3541 (E13) and apply to it just the same.

E13.3541

E13.3541 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye

Billable / specific codeICD-10-CM

E13.3541 is a billable, specific ICD-10-CM code for other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, 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 codes in subcategory E13.35 to designate laterality of the disease:

1: right eye
2: left eye
3: bilateral
9: unspecified eye

Excludes1 inherited from the categories above E13.3541

These are not written on E13.3541, but they bind it: a note on a category applies to every code beneath it. Billing E13.3541 with anything listed here is a denial.

Written on E13 — Other specified diabetes mellitus

diabetes (mellitus) due to autoimmune process (E10.-)
diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
neonatal diabetes mellitus (P70.2)
type 1 diabetes mellitus (E10.-)

Other codes that can never be billed with E13.3541

These codes carry an Excludes1 note pointing at E13.3541. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading E13.3541 alone.

E10Type 1 diabetes mellitus
E11Type 2 diabetes mellitus
E09Drug or chemical induced diabetes mellitus
E08Diabetes mellitus due to underlying condition

Risk adjustment

E13.3541 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

E13.3541 is named in 56 Medicare coverage policies — 55 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
A52370Billing and Coding: Bevacizumab and biosimilars
A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars
A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilars

Code history

E13.3541 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share E13.354. If E13.3541 is not quite right, the correct code is usually one of these.

Questions about E13.3541

Is E13.3541 a billable ICD-10-CM code?: Yes. E13.3541 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does E13.3541 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 E13.3541?: E13.3541 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 E13.3541 (E13) and apply to it just the same.