E10.3513 vs E11
E10.3513 (Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral) 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.
Can these codes be reported together?
No — do not report together. E10.3513 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).
No — do not report together. E11 carries an Excludes1 note covering E10.3513: “type 1 diabetes mellitus (E10.-)”
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
| E10.3513Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral | E11Type 2 diabetes mellitus | |
|---|---|---|
| Billing status | Billable | Non-billable header |
| Classification | E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89) | E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89) |
| Definition | Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral is a billable ICD-10-CM diagnosis code (E10.3513). | Type 2 diabetes mellitus is a non-billable ICD-10-CM category code (E11). |
| 7th character | One of the following 7th characters is to be assigned to codes in subcategory E10.35 to designate laterality of the disease: | — |
| Includes | brittle diabetes (mellitus) diabetes (mellitus) due to autoimmune process diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction idiopathic diabetes (mellitus) | 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) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources