E11.3 vs H36
E11.3 (Type 2 diabetes mellitus with ophthalmic complications) compared with H36 (Retinal disorders in diseases classified elsewhere), 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. H36 carries an Excludes1 note covering E11.3: “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).
Side by side
| E11.3Type 2 diabetes mellitus with ophthalmic complications | H36Retinal disorders in diseases classified elsewhere | |
|---|---|---|
| Billing status | Non-billable header Report instead: E11.311, E11.319, E11.3211, E11.3212, E11.3213 | Non-billable header |
| Classification | E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89) | H00-H59 — Diseases of the Eye and Adnexa (H00-H59) |
| Definition | Type 2 diabetes mellitus with ophthalmic complications is a non-billable ICD-10-CM category code (E11.3). | Retinal disorders in diseases classified elsewhere is a non-billable ICD-10-CM category code (H36). |
| 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 first | — | underlying disease, such as: lipid storage disorders (E75.-) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources