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E08.3553 ICD-10-CM Code: Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral

Compare with another codeCheck this code on a claim

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

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
8 Excludes1 · 5 use-additional codes · 7 code-first instructions
Risk adjustment
CMS-HCC V28: 2 categories · CMS-HCC V22 category 122 · CMS-HCC V22 category 18 · RxHCC V08 category 30

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Code firstSequence the underlying condition before this code
  • the underlying condition, such as:
  • congenital rubella (P35.0)
  • Cushing's syndrome (E24.-)
  • cystic fibrosis (E84.-)

+3 more in Instructions

Use additional codeReport with this code when documented
  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)

+1 more in Instructions

Excludes1Never report with this code
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • neonatal diabetes mellitus (P70.2)
  • postpancreatectomy diabetes mellitus (E13.-)

+4 more in Instructions

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 008 — SIMULTANEOUS PANCREAS, ISLET CELL AND KIDNEY TRANSPLANT (MDC PRE)
  • MS-DRG 010 — PANCREAS OR ISLET CELL TRANSPLANT (MDC PRE)
  • MS-DRG 019 — SIMULTANEOUS PANCREAS, ISLET CELL 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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E08.3553 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on E08.3553 itself; “inherited from” names the category or block whose note applies here.

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).

Source: inherited from E08

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.-)

Source: inherited from E08

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)

Source: inherited from E08

7th Character Guide

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

  • 1 — right eye
  • 2 — left eye
  • 3 — bilateral (this page’s code)
  • 9 — unspecified eye

Variant codes in this family

E08.3551, E08.3552, E08.3553, E08.3559

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for E08.3553

MedCoder structured workflow — derived from this code’s own official record

Before you code E08.3553

  1. A 7th character is required in this family. Confirm the documentation supports the character assigned — its meaning in this family is defined in the official instruction. This page’s code carries “3”. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: bilateral). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    See the relationships section · Guide: Laterality coding →

  3. E08.3553’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  4. Confirm the documented diabetes type or cause (the E08–E13 categories are separated by it) and every documented complication or manifestation; the code is built from the type first and the complication second. Then work the category’s Use Additional Code notes for medication and control status. Type 2 is the default only when the type is not documented, and insulin or other medication use does not by itself establish the type (Guidelines I.C.4.a.2, I.C.4.a.3).

    Guide: Secondary diabetes (E08, E09, E13) →

  5. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E08.3553. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in E08.3553’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewE09, O24.4, P70.2, E13, E10, E11

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then E08.3553.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewP35.0, E24, E84

  3. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.
  4. Does the documentation support one of this family’s 7th-character values?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider E08.3553. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Diabetes type or cause, each complication, and medication use
The type is documented, not inferred from medication (Guidelines I.C.4.a.3); each documented complication takes its own combination code.

Official instructions as workflow

  • Excludes1 — check before selecting E08.3553(8 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E08.3553: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE09, O24.4, P70.2, E13, E10, E11

    See the official tabular notes · Guidelines I.A.12.a

  • Code First — sequencing check(7 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before E08.3553. Do not add an underlying condition the record does not document.

    ReviewP35.0, E24, E84

    See the official tabular notes · Guidelines I.A.13

  • Use Additional Code — after identifying E08.3553(5 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with E08.3553 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewZ79.85, Z79.4, Z79.84

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E08.3553 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewE09, O24.4, P70.2, E13, E10, E11

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is E08.3553 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse E08.3553 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of E08.3553 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • E09— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of drug or chemical induced diabetes mellitus moves the case to E09; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs E09 →

  • O24.4— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of gestational diabetes moves the case to O24.4; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs O24.4 →

  • P70.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of neonatal diabetes mellitus moves the case to P70.2; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs P70.2 →

  • E13— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of postpancreatectomy diabetes mellitus moves the case to E13; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs E13 →

  • E10— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of type 1 diabetes mellitus moves the case to E10; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs E10 →

  • E11— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of type 2 diabetes mellitus moves the case to E11; the two are not reported together unless documented as unrelated.

    Full comparison: E08.3553 vs E11 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral is a billable ICD-10-CM diagnosis code (E08.3553).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00 -E89)

a. Diabetes mellitus The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 – E13 as needed to identify all of the associated conditions that the patient has.

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00 -E89)

6) Secondary diabetes mellitus Codes under categories E08, Diabetes mellitus due to underlying condition, E09, Drug or chemical induced diabetes mellitus, and E13, Other specified diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00 -E89)

(b) Assigning and sequencing secondary diabetes codes and its causes The sequencing of the secondary diabetes codes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08, E09 and E13.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

g. Diabetes mellitus in pregnancy Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant patients who are diabetic should be assigned a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  3. Sequencing: 7 Code First instructions — the underlying condition is sequenced before this code when present. See the Code First notes
  4. 5 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  5. 8 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • 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 in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name E08.3553 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.

Referenced by 24 Excludes1 notes across 8 chapters: E09 — Drug or chemical induced diabetes mellitus (via E08.-), E10 — Type 1 diabetes mellitus (via E08.-), E11 — Type 2 diabetes mellitus (via E08.-), E13 — Other specified diabetes mellitus (via E08.-), E74 — Other disorders of carbohydrate metabolism (via E08.-), E87.2 — Acidosis (via E08.-), G54.5 — Neuralgic amyotrophy (via E08.-), G59 — Mononeuropathy in diseases classified elsewhere (via E08.-), G63 — Polyneuropathy in diseases classified elsewhere (via E08.-), G99.0 — Autonomic neuropathy in diseases classified elsewhere (via E08.-), H20.0 — Acute and subacute iridocyclitis (via E08.-), H36 — Retinal disorders in diseases classified elsewhere (via E08.3.-), I73.8 — Other specified peripheral vascular diseases (via E08.-), I79.8 — Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere (via E08.-), L92.1 — Necrobiosis lipoidica, not elsewhere classified (via E08.-), L99 — Other disorders of skin and subcutaneous tissue in diseases classified elsewhere (via E08.-), M14 — Arthropathies in other diseases classified elsewhere (via E08.-), M14.6 — Charcôt's joint (via E08.-), M90 — Osteopathies in diseases classified elsewhere (via E08.-), N08 — Glomerular disorders in diseases classified elsewhere (via E08.-), +4 more.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Excludes2 notes across 3 chapters: H35 — Other retinal disorders (via E08.-), I96 — Gangrene, not elsewhere classified (via E08.-), R11.15 — Cyclical vomiting syndrome unrelated to migraine (via E08.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: D84.81 — Immunodeficiency due to conditions classified elsewhere (via E08.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Code Also instruction: N76.82 — Fournier disease of vagina and vulva (via E08.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

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.

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.

Related Codes

Principal diagnosis restriction (Medicare Code Editor)

Manifestation code — the underlying condition is sequenced first.

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Categories (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage, Diabetes with Chronic Complications) for risk-adjusted payment.

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, 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, E08.3541 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye, E08.3542 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left 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, E08.3551 — 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, E08.3559 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye, E08.3591 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye, E08.3592 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye, E08.3593 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral, E08.3599 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye, E08.36 — Diabetes mellitus due to underlying condition with diabetic cataract, E08.37X1 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye, E08.37X2 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye, E08.37X3 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral, E08.37X9 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye, +319 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Pancreas Transplant Status, Diabetes with Severe Acute Complications, Diabetes with Glycemic, Unspecified, or No Complications

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).

E08.3531 — 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, 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, E08.3541 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye, E08.3542 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left 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, E08.3551 — 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, E08.3559 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye, E08.359 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, E08.3591 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye, E08.3592 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye, E08.3593 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral, E08.3599 — Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye, E08.36 — Diabetes mellitus due to underlying condition with diabetic cataract, E08.37X1 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye, E08.37X2 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye, E08.37X3 — Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral, +903 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

HbA1c Test (Glycated Hemoglobin), Blood Glucose Test, Iron Panel, Lipid Panel, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of E08.3553 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.

Run E08.3553 with these 13 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (24)

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]— CMS-HCC V28 · 2026
  • HCC 37 — Diabetes with Chronic Complications [CMS-HCC]: “Diabetes with Chronic Complications — supersedes HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • 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. 175 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • 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. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (40)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Does E08.3553 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:.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

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

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E08.3553 — Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/e08.3553-diabetes-mellitus-due-to-underlying-condition-with-stable-proliferative-diabetic-retinopathy-bilateral

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E08.3553 in its code family, with their registry titles.

View all codes in the E08 family