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E09.359 vs H35.9

E09.359 (Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema) compared with H35.9 (Unspecified retinal disorder), from the official CMS tabular data.

Summary

These codes can be reported together when both conditions are documented, because H35.9 lists E09.359 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named, billing status and chapter.E09.359 is “Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema”; H35.9 is “Unspecified retinal disorder”. E09.359 is a non-billable header; H35.9 is billable. E09.359 sits in E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89); H35.9 in H00-H59 — Diseases of the Eye and Adnexa (H00-H59).

Registry fact

Can these codes be reported together?

Yes, when both are documented.H35.9 lists E09.359 under Excludes2: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. E09.359 carries 8 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.H35.9’s tabular entry: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”. The note covers E09.359.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

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

Is one a parent or header code?

One is a header.E09.359 is a non-billable header, but H35.9 is not one of its subdivisions.

Registry fact

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?

Informational

Excludes2 relationship

H35.9
Unspecified retinal disorder
↔
E09.359
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema

What we found

Yes, when both are documented.H35.9 carries an Excludes2 note covering E09.359: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2026

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

E09.359Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edemaH35.9Unspecified retinal disorder
Billing statusNon-billable header

Report instead: E09.3591, E09.3592, E09.3593, E09.3599

Billable
ClassificationE00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)H00-H59 — Diseases of the Eye and Adnexa (H00-H59)
DefinitionDrug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E09.359).Unspecified retinal disorder is a billable ICD-10-CM diagnosis code (H35.9).
7th characterOne of the following 7th characters is to be assigned to codes in subcategory E09.35 to designate laterality of the disease:—
Excludes1
diabetes mellitus due to underlying condition (E08.-)
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.-)
—
Excludes2—
diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)
Code first
poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
—
Use additional code
code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
code to identify control using:
injectable non-insulin antidiabetic drugs (Z79.85)
—

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.

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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