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E09.3551 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye

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

Risk adjustment
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
  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
Use additional codeReport with this code when documented
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)

+2 more in Instructions

Excludes1Never report with this code
  • diabetes mellitus due to underlying condition (E08.-)
  • 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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E09.3551 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 E09.3551 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 E09

Code First

Underlying conditions that must be sequenced before this code.

  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Source: inherited from E09

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
  • 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 E09

7th Character Guide

"One of the following 7th characters is to be assigned to codes in subcategory E09.35 to designate laterality of the disease:"

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

Variant codes in this family

E09.3551, E09.3552, E09.3553, E09.3559

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 E09.3551

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

Before you code E09.3551

  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 “1”. 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: right). 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. E09.3551’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 E09.3551. 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 E09.3551’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.

    ReviewE08, 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 E09.3551.
    No → Continue; do not add an underlying condition the record does not document.
  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 E09.3551. 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 E09.3551(8 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E09.3551: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE08, O24.4, P70.2, E13, E10, E11

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

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before E09.3551. Do not add an underlying condition the record does not document.

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

  • Use Additional Code — after identifying E09.3551(6 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with E09.3551 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 E09.3551 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).

ReviewE08, 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 E09.3551 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.

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

Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye is a billable ICD-10-CM diagnosis code (E09.3551).

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)

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.

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: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  4. 6 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

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 E09.3551 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: E08 — Diabetes mellitus due to underlying condition (via E09.-), E10 — Type 1 diabetes mellitus (via E09.-), E11 — Type 2 diabetes mellitus (via E09.-), E13 — Other specified diabetes mellitus (via E09.-), E74 — Other disorders of carbohydrate metabolism (via E09.-), E87.2 — Acidosis (via E09.-), G54.5 — Neuralgic amyotrophy (via E09.-), G59 — Mononeuropathy in diseases classified elsewhere (via E09.-), G63 — Polyneuropathy in diseases classified elsewhere (via E09.-), G99.0 — Autonomic neuropathy in diseases classified elsewhere (via E09.-), H20.0 — Acute and subacute iridocyclitis (via E09.-), H36 — Retinal disorders in diseases classified elsewhere (via E09.3.-), I73.8 — Other specified peripheral vascular diseases (via E09.-), I79.8 — Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere (via E09.-), L92.1 — Necrobiosis lipoidica, not elsewhere classified (via E09.-), L99 — Other disorders of skin and subcutaneous tissue in diseases classified elsewhere (via E09.-), M14 — Arthropathies in other diseases classified elsewhere (via E09.-), M14.6 — Charcôt's joint (via E09.-), M90 — Osteopathies in diseases classified elsewhere (via E09.-), N08 — Glomerular disorders in diseases classified elsewhere (via E09.-), +4 more.

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

Referenced by 2 Excludes2 notes across 2 chapters: H35 — Other retinal disorders (via E09.-), I96 — Gangrene, not elsewhere classified (via E09.-).

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 E09.-).

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 E09.-).

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 (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 condition, opposite side

Same category and title, differing only in which side of the body is affected.

E09.3552 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye (left)Compare E09.3551 vs E09.3552 →, E09.3553 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral (bilateral)Compare E09.3551 vs E09.3553 →, E09.3559 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye (unspecified)Compare E09.3551 vs E09.3559 →

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).

E09.3523 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral, E09.3529 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye, E09.3531 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye, E09.3532 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye, E09.3533 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral, E09.3539 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye, E09.3541 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye, E09.3542 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye, E09.3543 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral, E09.3549 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye, E09.3552 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye, E09.3553 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral, E09.3559 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye, E09.359 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, E09.3591 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye, E09.3592 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye, E09.3593 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral, E09.3599 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye, E09.36 — Drug or chemical induced diabetes mellitus with diabetic cataract, E09.37X1 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye, +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 E09.3551 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 E09.3551 with these 12 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (24)

Referenced by Excludes2 notes

  • H35 — Other retinal disorders[Excludes2](via E09.-): “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027
  • I96 — Gangrene, not elsewhere classified[Excludes2](via E09.-): “gangrene in diabetes mellitus (E08-E13 with .52)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

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 E09.3551 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E09.35 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
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. "E09.3551 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/e09.3551-drug-or-chemical-induced-diabetes-mellitus-with-stable-proliferative-diabetic-retinopathy-right-eye

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E09.3551 in its code family, with their registry titles.

View all codes in the E09 family