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E08.359 vs E11

E08.359 (Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema) compared with E11 (Type 2 diabetes mellitus), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.

Relationship

Conflict

Excludes1 conflict

E08.359
Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema
↔
E11
Type 2 diabetes mellitus

Not coded here — these two are mutually exclusive.

“type 2 diabetes mellitus (E11.-)”

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

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

Can these codes be reported together?

No — do not report together. E08.359 carries an Excludes1 note covering E11: “type 2 diabetes mellitus (E11.-)”

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

Side by side

E08.359Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edemaE11Type 2 diabetes mellitus
Billing statusNon-billable header

Report instead: E08.3591, E08.3592, E08.3593, E08.3599

Non-billable header

Report instead: E11.00, E11.01, E11.10, E11.11, E11.21

ClassificationE00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)
DefinitionDiabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E08.359).Type 2 diabetes mellitus is a non-billable ICD-10-CM category code (E11).
7th characterOne of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:—
Includes—
diabetes (mellitus) due to insulin secretory defect
diabetes NOS
insulin resistant diabetes (mellitus)
Use additional code
code to identify control using:
injectable non-insulin antidiabetic drugs (Z79.85)
insulin (Z79.4)
code to identify control using:
injectable non-insulin antidiabetic drugs (Z79.85)
insulin (Z79.4)
Code first
the underlying condition, such as:
congenital rubella (P35.0)
—
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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources