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E08.3 vs H36.822

E08.3 (Diabetes mellitus due to underlying condition with ophthalmic complications) compared with H36.822 (Proliferative sickle-cell retinopathy, left eye), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes should not be reported together because H36.822’s tabular entry lists E08.3 under Excludes1.

Official rule
What is different?

The conditions named, billing status and chapter.E08.3 is “Diabetes mellitus due to underlying condition with ophthalmic complications”; H36.822 is “Proliferative sickle-cell retinopathy, left eye”. E08.3 is a non-billable header; H36.822 is billable. E08.3 sits in E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89); H36.822 in H00-H59 — Diseases of the Eye and Adnexa (H00-H59).

Registry fact

Can these codes be reported together?

No.H36.822’s entry carries an Excludes1 note covering E08.3: “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.H36.822’s tabular entry: “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)”. The note covers E08.3.

Official ruleGuide: Excludes1 vs Excludes2

Is one a parent or header code?

One is a header.E08.3 is a non-billable header, but H36.822 is not one of its subdivisions.

Registry fact

Nothing found in 3 other checks; 1 check does not apply
Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

H36.822
Proliferative sickle-cell retinopathy, left eye
↔
E08.3
Diabetes mellitus due to underlying condition with ophthalmic complications

What we found

No — do not report together.H36.822 carries an Excludes1 note covering E08.3: “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
E08.3

Diabetes mellitus due to underlying condition with ophthalmic complications

H36.822

Proliferative sickle-cell retinopathy, left eye

StatusDiffers
E08.3
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: E08.311, E08.319, E08.3211, E08.3212, E08.3213

H36.822
Billable
Excludes1Differs
E08.3
  • 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.-)
  • type 2 diabetes mellitus (E11.-)
H36.822
  • arteriosclerotic retinopathy (H35.0-)
  • diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)
Code firstDiffers
E08.3
  • the underlying condition, such as:
  • congenital rubella (P35.0)
  • Cushing's syndrome (E24.-)
  • cystic fibrosis (E84.-)
  • malignant neoplasm (C00-C96)
  • malnutrition (E40-E46)
  • pancreatitis and other diseases of the pancreas (K85-K86.-)
H36.822
  • underlying disease, such as:
  • lipid storage disorders (E75.-)
  • sickle-cell disorders (D57.-)
Use additional codeDiffers
E08.3
  • 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)
H36.822

None at this code

CategoryDiffers
E08.3

E08 Diabetes mellitus due to underlying condition

H36.822

H36 Retinal disorders in diseases classified elsewhere

ChapterDiffers
E08.3

E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)

H36.822

H00-H59 — Diseases of the Eye and Adnexa (H00-H59)

No Excludes2, Code also, Includes and 7th character note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources