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E09.359 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema

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

Code Overview

Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E09.359). A more specific billable subcode must be selected for claims submission.

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

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E09.359 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.

  • poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4) 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) inherited from E09
  • Use additional code to identify control using: inherited from E09
  • injectable non-insulin antidiabetic drugs (Z79.85) inherited from E09
  • insulin (Z79.4) inherited from E09
  • oral antidiabetic drugs (Z79.84) inherited from E09
  • oral hypoglycemic drugs (Z79.84) inherited from E09

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

  • Diabetes, diabetic (mellitus) (sugar), due to drug or chemical, with, retinopathy, proliferative

Frequently Compared Codes

The official Excludes notes on E09.359 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2017 — 2016-10-01
    Became a non-billable header
    FY2017 changes
  • FY2016 — 2015-10-01
    In the code set at ICD-10-CM adoption
    Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema

Verify Before Coding

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

Other codes that name E09.359 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 5 Excludes1 notes across 2 chapters: E08 (via E09.-), E10 (via E09.-), E11 (via E09.-), E13 (via E09.-), H36 (via E09.3.-).

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

Referenced by 1 Excludes2 note: H35.

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

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).

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, E09.3551 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right 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, E09.3591 — 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, E09.37X2 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye, E09.37X3 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral, E09.37X9 — Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye, E09.39 — Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication, +903 more

Contextual Map

Every relationship of E09.359 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

  • E08 — Diabetes mellitus due to underlying condition [Excludes1](via E09.-): “drug or chemical induced diabetes mellitus (E09.-)” · check together
  • E10 — Type 1 diabetes mellitus [Excludes1](via E09.-): “drug or chemical induced diabetes mellitus (E09.-)” · check together
  • E11 — Type 2 diabetes mellitus [Excludes1](via E09.-): “drug or chemical induced diabetes mellitus (E09.-)” · check together
  • E13 — Other specified diabetes mellitus [Excludes1](via E09.-): “drug or chemical induced diabetes mellitus (E09.-)” · check together
  • H36 — Retinal disorders in diseases classified elsewhere [Excludes1](via E09.3.-): “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)” · check together

Referenced by Excludes2 notes

  • H35 — Other retinal disorders [Excludes2]: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)” · 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 drug or chemical, with, retinopathy, proliferative[Index term]

Nearest codes (40)

  • E09 — Drug or chemical induced diabetes mellitus [Sibling]
  • E09.352 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula [Sibling]
  • E09.3521 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye [Sibling]
  • E09.3522 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye [Sibling]
  • E09.3523 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral [Sibling]
  • E09.3529 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye [Sibling]
  • E09.353 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula [Sibling]
  • E09.3531 — Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye [Sibling]
  • and 32 more

Change history (2)

  • FY2017 — Became a non-billable header [Change history]
  • and 1 more

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E09.359 be billed directly?

No. E09.359 (Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does E09.359 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:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E09.359 in its code family, with their registry titles.

  • E09.355 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy
  • E09.3551 — Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right 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
  • E09.3591 — 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

View all codes in the E09 family