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ICD-10/E08.3542

E08.3542 ICD-10-CM Code: Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)
  • MS-DRG 010 — PANCREAS TRANSPLANT (MDC PRE)
  • MS-DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)
  • MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
  • MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
  • HCC 37 — Diabetes with Chronic Complications (supersedes HCC 38)

Other models: CMS-HCC V22 HCC 122 · CMS-HCC V22 HCC 18 · RxHCC V08 HCC 30

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Official Registry Overview & Definition

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye is a billable ICD-10-CM diagnosis code (E08.3542).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E08.3542 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)

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
    FY2017 changes

Verify Before Coding

  • Billable — reportable as written.
  • Principal-diagnosis restriction. This is a manifestation code: the Medicare Code Editor requires the underlying condition (etiology) to be sequenced first, with this code reported after it.

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

Contextual Map

Every relationship of E08.3542 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]

Risk adjustment (CMS-HCC)

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]
  • HCC 37 — Diabetes with Chronic Complications [CMS-HCC]: “Diabetes with Chronic Complications — supersedes HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications)”

Potential MS-DRG

  • DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)”
  • DRG 010 — PANCREAS TRANSPLANT [MS-DRG]: “PANCREAS TRANSPLANT (MDC PRE)”
  • DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)”
  • DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT [MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”
  • DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC [MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”

MDC crossing · procedures (1353)

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 02 — Diseases and Disorders of the Eye [MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 02HA0QZ — Insertion of Implantable Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA0RZ — Insertion of Short-term External Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Short-term External Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA3QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA4QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02RA0LZ — Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach [Same-MDC procedure]: “Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • and 1348 more

Nearest codes (40)

  • E08 — Diabetes mellitus due to underlying condition [Sibling]
  • E08.3493 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral [Sibling]
  • E08.3499 — Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye [Sibling]
  • E08.35 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy [Sibling]
  • E08.351 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema [Sibling]
  • E08.3511 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye [Sibling]
  • E08.3512 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye [Sibling]
  • E08.3513 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication; 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.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 5 MS-DRGs: DRG 008 (MDC PRE), DRG 010 (MDC PRE), DRG 019 (MDC PRE), DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name E08.3542 or its code family.

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.-) and 13 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.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does E08.3542 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 E08.3542 in its code family, with their registry titles.

  • E08.3532 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye
  • E08.3533 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral
  • E08.3539 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye
  • E08.354 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment
  • E08.3541 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
  • E08.3543 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
  • E08.3549 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
  • E08.355 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy
  • E08.3551 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye
  • E08.3552 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye

View all codes in the E08 family