Coding and coverage · ICD-10-CM

E11 › E11.3 › E11.33

E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema

Not billable (header)Chapter 4

This code needs a 7th character (use X as a placeholder for missing characters).

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7th character codes

  • E11.3311 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
  • E11.3312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
  • E11.3313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
  • E11.3319 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye

Instructional notes

Chapter 4

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • transitory endocrine and metabolic disorders specific to newborn (P70-P74)
Notes
  • All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.

E11

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • 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.-)
Use additional codeAdd a second code for the full picture.
  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)
  • oral hypoglycemic drugs (Z79.84)
Includes
  • diabetes (mellitus) due to insulin secretory defect
  • diabetes NOS
  • insulin resistant diabetes (mellitus)

E11.33

7th charactersOne of the following 7th characters is to be assigned to codes in subcategory E11.33 to designate laterality of the disease:
  • 1 right eye
  • 2 left eye
  • 3 bilateral
  • 9 unspecified eye

Chapter 4: Endocrine, nutritional and metabolic diseases · E08-E13 Diabetes mellitus (E08-E13)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.