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E11.3552 vs P70.2

E11.3552 (Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye) compared with P70.2 (Neonatal diabetes mellitus), from the official CMS tabular data.

Summary

These codes should not be reported together because E11.3552’s tabular entry lists P70.2 under Excludes1.

Official rule
What is different?

The conditions named and chapter.E11.3552 is “Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye”; P70.2 is “Neonatal diabetes mellitus”. E11.3552 sits in E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89); P70.2 in P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96).

Registry fact

Can these codes be reported together?

No.E11.3552’s entry carries an Excludes1 note covering P70.2: “neonatal diabetes mellitus (P70.2)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.E11.3552’s tabular entry: “neonatal diabetes mellitus (P70.2)”. The note covers P70.2.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code.

Official rule

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?

No.Both are billable codes, and neither contains the other.

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?

Excludes1 — generally not reported together

Excludes1 conflict

E11.3552
Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
↔
P70.2
Neonatal diabetes mellitus

What we found

No — do not report together.E11.3552 carries an Excludes1 note covering P70.2: “neonatal diabetes mellitus (P70.2)”

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

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

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

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    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

E11.3552Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eyeP70.2Neonatal diabetes mellitus
Billing statusBillableBillable
ClassificationE00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96)
DefinitionType 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye is a billable ICD-10-CM diagnosis code (E11.3552).Neonatal diabetes mellitus is a billable ICD-10-CM diagnosis code (P70.2).
7th characterOne of the following 7th characters is to be assigned to codes in subcategory E11.35 to designate laterality of the disease:—
Includes
diabetes (mellitus) due to insulin secretory defect
diabetes NOS
insulin resistant diabetes (mellitus)
transitory endocrine and metabolic disturbances caused by the infant's response to maternal endocrine and metabolic factors, or its adjustment to extrauterine environment
Excludes1
diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
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.-)
—
Use additional code
code to identify control using:
injectable non-insulin antidiabetic drugs (Z79.85)
insulin (Z79.4)
—

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