E13.3559: Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
E13.3559 is a billable, specific ICD-10-CM code for other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye. It is valid for submission on a claim.
Check E13.3559 with the rest of the claim: free scrubber7th 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
Excludes1 inherited from the categories above E13.3559
A category’s note binds every code beneath it.
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 E13.3559
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
E13.3559 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
E13.3559 is named in 12 Medicare coverage policies: 12 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52464Glucose Monitor - Policy Article
- A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
- A52507External Infusion Pumps - Policy Article
- A56232Billing and Coding: Foot Care
Code history
Unchanged in every release from FY2024 to FY2027.