InnovaRx Innova Health Strategies

E13.3412

Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

Billable FY2026 2025-10-01 → 2026-09-30
Exclusions 8 never code together
E13code
Excludes1
  • diabetes (mellitus) due to autoimmune process (E10.-)E10.-
  • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)E10.-
  • diabetes mellitus due to underlying condition (E08.-)E08.-
  • drug or chemical induced diabetes mellitus (E09.-)E09.-
  • gestational diabetes (O24.4-)O24.4-
  • neonatal diabetes mellitus (P70.2)P70.2
  • type 1 diabetes mellitus (E10.-)E10.-
E00-E89chapter
Excludes1
  • transitory endocrine and metabolic disorders specific to newborn (P70-P74)P70-P74

Excludes1 — never code together. The excluded condition and this one are mutually exclusive.

7th character 4
1 right eye
2 left eye this code
3 bilateral
9 unspecified eye
Instructional notes 11
E13code
Includes
  • diabetes mellitus due to genetic defects of beta-cell function
  • diabetes mellitus due to genetic defects in insulin action
  • postpancreatectomy diabetes mellitus
  • postprocedural diabetes mellitus
  • secondary diabetes mellitus NEC
Use additional code
  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)Z79.85
  • insulin (Z79.4)Z79.4
  • oral antidiabetic drugs (Z79.84)Z79.84
  • oral hypoglycemic drugs (Z79.84)Z79.84
E00-E89chapter
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.E05.8E07.0E16-E31E34.-
Index entries leading here 1
  • Aneurysm (anastomotic) (artery) (cirsoid) (diffuse) (false) (fusiform) (multiple) (saccular) I72.9
    • retina — see also Disorder, retina, microaneurysms
      • diabetic — see E08-E13 with .3-
Alongside this code 3 same parent — E13.341
Medications 5

MED-RT files conditions by MeSH, which carves the world differently from ICD-10. These are name matches on this code's description, offered as candidates — not as an assertion that they are this code.

Additional references
AHA Coding Clinic® Licence required

Official coding advice for this code. Published by the American Hospital Association. Not included in this installation.

Risk adjustment

CMS22HCC18 CMS28HCC298 · HCC37 ESRD21HCC18 ESRD24HCC18 RX08HCC30

Presence is a property of the code. Untick a model to hide it everywhere.

This code

Billable
yes
Code set
FY2026
Parent
E13.341
Block
E08-E13
Siblings
3

Present FY2024–FY2027.