E13.351 vs E13.3511
E13.351 (Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema) compared with E13.3511 (Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye), from the official CMS tabular data.
Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources
Summary
These codes represent different levels of the same hierarchy: E13.351 is the non-billable header that contains E13.3511, so only E13.3511 (or a sibling) is reported.
Registry fact- What is different?
Title wording and billing status.E13.3511’s title adds “right eye” to the wording the two share (“Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema”). E13.351 is a non-billable header; E13.3511 is billable.
Registry fact
- Can these codes be reported together?
Not as a pair.E13.351 is the non-billable header that contains E13.3511. A header is not reported on a claim, so the choice is E13.3511 or a sibling that matches the documentation.
Registry fact
- Is there an Excludes1 relationship?
None.Neither entry carries an Excludes1 note that names the other code. E13.351 carries 7 Excludes1 notes and E13.3511 carries 7 Excludes1 notes covering other codes; the side-by-side table quotes them.
Official rule
- Is there an Excludes2 relationship?
None.Neither entry carries an Excludes2 note that names the other code.
Official rule
- Is one more specific?
Yes.E13.3511 is a subdivision of E13.351 in the tabular hierarchy, so it is the more specific of the two.
Registry fact
- Is one a parent or header code?
Yes.E13.351 is the non-billable header that contains E13.3511. A header stands for the whole family beneath it and is not reported on a claim.
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?
Not as a pair — E13.351 is not reportable. E13.351 is the non-billable category that contains E13.3511.
A header stands for the whole family of codes beneath it and is not reported on a claim, so the choice is E13.3511 or a sibling that matches the documentation. No Excludes1/Excludes2 relationship exists between these codes in the official tabular list.
Official guidance behind these answers
Section I.B.2 — Level of Detail in Coding · applies to: E13.351 and E13.3511
Diagnosis codes are to be used and reported at their highest number of characters available and to the highest level of specificity documented in the medical record. ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth characters and/or sixth characters, which provide greater detail. A three-character code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.
ICD-10-CM Official Guidelines FY2027
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
Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
- diabetes (mellitus) due to autoimmune process (E10.-)
- diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- type 1 diabetes mellitus (E10.-)
- code to identify control using:
- injectable non-insulin antidiabetic drugs (Z79.85)
- insulin (Z79.4)
E13 Other specified diabetes mellitus
E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)
- diabetes mellitus due to genetic defects of beta-cell function
- diabetes mellitus due to genetic defects in insulin action
- postpancreatectomy diabetes mellitus
- postprocedural diabetes mellitus
- One of the following 7th characters is to be assigned to codes in subcategory E13.35 to designate laterality of the disease:
No Excludes2, Code first and Code also note at either code.
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. In a row that differs, notes every code shares are dimmed.
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