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E08.351 ICD-10-CM Code: Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Official Registry Overview & Definition

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema is a non-billable ICD-10-CM category code (E08.351). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E08.351 in the official ICD-10-CM tabular list.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Code First

Underlying conditions that must be sequenced before this code.

  • the underlying condition, such as:
  • congenital rubella (P35.0)
  • Cushing's syndrome (E24.-)
  • cystic fibrosis (E84.-)
  • malignant neoplasm (C00-C96)
  • malnutrition (E40-E46)
  • pancreatitis and other diseases of the pancreas (K85-K86.-)

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)
  • oral hypoglycemic drugs (Z79.84)

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Diabetes, diabetic (mellitus) (sugar), due to underlying condition, with, retinopathy, proliferative, with, macular edema

Frequently Compared Codes

The official Excludes notes on E08.351 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

Verify Before Coding

  • Not billable as written — a more specific code is required.
  • Requires a 7th character. "One of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:" Options: E08.3511, E08.3512, E08.3513, E08.3519

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Relationships & Classification

Other codes that name E08.351 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

23 Excludes1 notes across 8 chapters: E09 (via E08.-), E10 (via E08.-), E11 (via E08.-), E13 (via E08.-), E74 (via E08.-), G54.5 (via E08.-), G59 (via E08.-), G63 (via E08.-), G99.0 (via E08.-), H20.0 (via E08.-), H36 (via E08.3.-), I73.8 (via E08.-), I79.8 (via E08.-), L92.1 (via E08.-), L99 (via E08.-), M14 (via E08.-), M14.6 (via E08.-), M90 (via E08.-), N08 (via E08.-), N16 (via E08.-), +3 more.

2 Excludes2 notes across 2 chapters: I96 (via E08.-), R11.15 (via E08.-).

1 Code First instructions: D84.81 (via E08.-).

1 Code Also instructions: N76.82 (via E08.-).

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END006 — Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type; EYE005 — Retinal and vitreous conditions.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Diabetes mellitus with complication, Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type, Retinal and vitreous conditions).

E08.341 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, E08.3411 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye, E08.3412 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye, E08.3413 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral, E08.3419 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye, E08.349 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, E08.3491 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye, E08.3492 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye, E08.3493 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral, E08.3499 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye, E08.3511 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye, E08.3512 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye, E08.3513 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral, E08.3519 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye, E08.3521 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye, E08.3522 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye, E08.3523 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral, E08.3529 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye, E08.3531 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye, E08.3532 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye, +903 more

Contextual Map

Every relationship of E08.351 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • E00-E89 — Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E89) (E00-E89) [Hierarchy]
  • E08-E13 — Diabetes mellitus [Hierarchy]

Referenced by Excludes1 notes (23)

  • E09 — Drug or chemical induced diabetes mellitus [Excludes1](via E08.-): “diabetes mellitus due to underlying condition (E08.-)” · check together
  • E10 — Type 1 diabetes mellitus [Excludes1](via E08.-): “diabetes mellitus due to underlying condition (E08.-)” · check together
  • E11 — Type 2 diabetes mellitus [Excludes1](via E08.-): “diabetes mellitus due to underlying condition (E08.-)” · check together
  • E13 — Other specified diabetes mellitus [Excludes1](via E08.-): “diabetes mellitus due to underlying condition (E08.-)” · check together
  • E74 — Other disorders of carbohydrate metabolism [Excludes1](via E08.-): “diabetes mellitus (E08-E13)” · check together
  • G54.5 — Neuralgic amyotrophy [Excludes1](via E08.-): “neuralgic amyotrophy in diabetes mellitus (E08-E13 with .44)” · check together
  • G59 — Mononeuropathy in diseases classified elsewhere [Excludes1](via E08.-): “diabetic mononeuropathy (E08-E13 with .41)” · check together
  • G63 — Polyneuropathy in diseases classified elsewhere [Excludes1](via E08.-): “diabetes mellitus (E08-E13 with .42)” · check together
  • and 15 more

Referenced by Excludes2 notes

  • I96 — Gangrene, not elsewhere classified [Excludes2](via E08.-): “gangrene in diabetes mellitus (E08-E13 with .52)” · check together
  • R11.15 — Cyclical vomiting syndrome unrelated to migraine [Excludes2](via E08.-): “diabetes mellitus due to underlying condition (E08.-)” · check together

Referenced by Code First instructions

  • D84.81 — Immunodeficiency due to conditions classified elsewhere [Code First](via E08.-): “diabetes mellitus (E08-E13)” · check together

Referenced by Code Also instructions

  • N76.82 — Fournier disease of vagina and vulva [Code Also](via E08.-): “, if applicable, diabetes mellitus (E08-E13 with .9)” · check together

Clinical classification (CCSR)

  • END003 — Diabetes mellitus with complication [CCSR]
  • END006 — Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type [CCSR]
  • EYE005 — Retinal and vitreous conditions [CCSR]

Index entries

  • Diabetes, diabetic (mellitus) (sugar), due to underlying condition, with, retinopathy, proliferative, with, macular edema[Index term]

Nearest codes (40)

  • E08 — Diabetes mellitus due to underlying condition [Sibling]
  • E08.3312 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye [Sibling]
  • E08.3313 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral [Sibling]
  • E08.3319 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye [Sibling]
  • E08.339 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema [Sibling]
  • E08.3391 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye [Sibling]
  • E08.3392 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye [Sibling]
  • E08.3393 — Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral [Sibling]
  • and 32 more

Change history

  • FY2017 — Became a non-billable header [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E08.351 be billed directly?

No. E08.351 (Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does E08.351 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E08.351 in its code family, with their registry titles.

  • E08.3491 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye
  • E08.3492 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye
  • E08.3493 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral
  • E08.3499 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye
  • E08.35 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy
  • E08.3511 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye
  • E08.3512 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye
  • E08.3513 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral
  • E08.3519 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye
  • E08.352 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula

View all codes in the E08 family