{"code":"E11.3513","type":"code","title":"Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral","codeAlso":[],"includes":["diabetes (mellitus) due to insulin secretory defect","diabetes NOS","insulin resistant diabetes (mellitus)"],"modern_v":"official26","codeFirst":[],"excludes1":["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.-)"],"excludes2":[],"isBillable":true,"fyEffectivity":{"fy2026":true,"fy2027":true,"billableFy2026":true,"billableFy2027":true},"inclusionTerms":[],"useAdditionalCode":["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)"],"clinicalDefinition":"Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral is a billable ICD-10-CM diagnosis code (E11.3513). Includes: diabetes (mellitus) due to insulin secretory defect; diabetes NOS; insulin resistant diabetes (mellitus). Excludes1 (not coded here): diabetes mellitus due to underlying condition (E08.-); drug or chemical induced diabetes mellitus (E09.-); gestational diabetes (O24.4-); neonatal diabetes mellitus (P70.","officialDefinition":"Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral is a billable ICD-10-CM diagnosis code (E11.3513). Includes: diabetes (mellitus) due to insulin secretory defect; diabetes NOS; insulin resistant diabetes (mellitus). Excludes1 (not coded here): 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 code: 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). 7th character: One of the following 7th characters is to be assigned to codes in subcategory E11.35 to designate laterality of the disease:.","seventhCharacterInstructions":["One of the following 7th characters is to be assigned to codes in subcategory E11.35 to designate laterality of the disease:"],"workflowProtocols":[],"guidelines":{"whenToUse":[],"whenNotToUse":[],"commonBillingMistakes":[],"codeComparisons":[],"documentationChecklist":[]},"domainLandscape":{"summary":"Primary diagnostic domain and clinical landscape evaluation.","keyCategories":[],"diagnosticContinuum":"Progression continuum from acute presentation to resolution."},"children":[],"hierarchy":[],"relatedCodes":[],"relevantCPTCodes":[],"documentationTips":[],"caseStudies":[],"description":"","overview":"","noteProvenance":{"diabetes mellitus due to underlying condition (E08.-)":"E11","drug or chemical induced diabetes mellitus (E09.-)":"E11","gestational diabetes (O24.4-)":"E11","neonatal diabetes mellitus (P70.2)":"E11","postpancreatectomy diabetes mellitus (E13.-)":"E11","postprocedural diabetes mellitus (E13.-)":"E11","secondary diabetes mellitus NEC (E13.-)":"E11","type 1 diabetes mellitus (E10.-)":"E11","code to identify control using:":"E11","injectable non-insulin antidiabetic drugs (Z79.85)":"E11","insulin (Z79.4)":"E11","oral antidiabetic drugs (Z79.84)":"E11","oral hypoglycemic drugs (Z79.84)":"E11","diabetes (mellitus) due to insulin secretory defect":"E11","diabetes NOS":"E11","insulin resistant diabetes (mellitus)":"E11"},"hcc":{"mapped":true,"model":"CMS-HCC V28","paymentYear":"2026","categories":[{"hcc":"298","label":"Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage","family":"","suppresses":[]},{"hcc":"37","label":"Diabetes with Chronic Complications","family":"Diabetes","suppresses":[{"hcc":"38","label":"Diabetes with Glycemic, Unspecified, or No Complications"}]}],"otherModels":[{"model":"CMS-HCC V22","hcc":"122"},{"model":"CMS-HCC V22","hcc":"18"},{"model":"RxHCC V08","hcc":"30"}]}}