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E09.359 vs O24.4

E09.359 (Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema) compared with O24.4 (Gestational 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

E09.359
Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema
↔
O24.4
Gestational diabetes mellitus

Not coded here — these two are mutually exclusive.

“gestational diabetes (O24.4-)”

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. E09.359 carries an Excludes1 note covering O24.4: “gestational diabetes (O24.4-)”

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

E09.359Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edemaO24.4Gestational diabetes mellitus
Billing statusNon-billable header

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

Non-billable header

Report instead: O24.410, O24.414, O24.415, O24.419, O24.420

ClassificationE00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A)
DefinitionDrug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E09.359).Gestational diabetes mellitus is a non-billable ICD-10-CM category code (O24.4).
7th characterOne of the following 7th characters is to be assigned to codes in subcategory E09.35 to designate laterality of the disease:—
Includes—
Diabetes mellitus arising in pregnancy
Gestational diabetes mellitus NOS
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)
—
Code first
poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
—
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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