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E10.331 ICD-10-CM Code: Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema

Compare with another code for E10.331Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
6 inclusion terms · 9 Excludes1

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

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, and is marked with where it comes from.

7th character:required: report a code with a 7th character· One of the following 7th characters is to be assigned to codes in subcategory E10.33 to designate laterality of the disease:See the 7th character note

Excludes1from E10Not reported with this code unless documented as unrelated
  • diabetes mellitus due to underlying condition (E08.-)
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • hyperglycemia NOS (R73.9)

+5 more in Instructions

Includesfrom E10What E10 covers
  • brittle diabetes (mellitus)
  • diabetes (mellitus) due to autoimmune process
  • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction
  • idiopathic diabetes (mellitus)

+2 more in Instructions

Where it sits Source: CMS/NCHS

Under:Chapter 4: Endocrine, Nutritional and Metabolic DiseasesE08-E13 Diabetes mellitusE10 Type 1 diabetes mellitusE10.3 Type 1 diabetes mellitus with ophthalmic complicationsE10.33 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy

Codes under E10.331 (4)

  • E10.3311Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eyeBillable
  • E10.3312Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eyeBillable
  • E10.3313Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateralBillable
  • E10.3319Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eyeBillable

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

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E10.331 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 E10.331 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • brittle diabetes (mellitus)
  • diabetes (mellitus) due to autoimmune process
  • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction
  • idiopathic diabetes (mellitus)
  • juvenile onset diabetes (mellitus)
  • ketosis-prone diabetes (mellitus)

Source: inherited from E10

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 E10

7th Character Guide

"One of the following 7th characters is to be assigned to codes in subcategory E10.33 to designate laterality of the disease:"

  • 1 — right eye
  • 2 — left eye
  • 3 — bilateral
  • 9 — unspecified eye

Variant codes in this family

E10.3311, E10.3312, E10.3313, E10.3319

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 E10.331

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

Before you code E10.331

  1. E10.331 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewE10.3311, E10.3312, E10.3313, E10.3319

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. 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. E10.331 is not valid without one. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  3. E10.331’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: Diabetes with multiple complications →

  5. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with the code beneath E10.331. 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 one of the more specific codes beneath E10.331?
    Yes → Select that code and continue the checks below on its own page.
    No → E10.331 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewE10.3311, E10.3312, E10.3313, E10.3319

  2. Does the documentation support a condition named in E10.331’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, E09, O24.4, R73.9, P70.2, E13

  3. 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.

Report the code beneath E10.331 that the documentation supports, not E10.331 itself. Then confirm that code is valid for the date of service on its own page.

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).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
Severity
Mild, moderate or severe as the provider states it; severity is not inferred from the clinical picture.
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).
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 E10.331(9 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E10.331: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE08, E09, O24.4, R73.9, P70.2, E13

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

Coding decision scenarios

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

Documentation: Both the condition E10.331 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, E09, O24.4, R73.9, P70.2, E13

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

Coding question: Is the code beneath E10.331 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 E10.331 with…

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

The codes most likely to be picked instead of E10.331 — 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.

  • E08— 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 diabetes mellitus due to underlying condition moves the case to E08; the two are not reported together unless documented as unrelated.

    Full comparison: E10.331 vs E08 →

  • 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: E10.331 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: E10.331 vs O24.4 →

  • R73.9— 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 hyperglycemia NOS moves the case to R73.9; the two are not reported together unless documented as unrelated.

    Full comparison: E10.331 vs R73.9 →

  • 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: E10.331 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: E10.331 vs E13 →

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

Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema is a non-billable ICD-10-CM category code (E10.331). A more specific billable subcode must be selected for claims submission.

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

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

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

Other codes that name E10.331 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 25 Excludes1 notes across 9 chapters: E08 — Diabetes mellitus due to underlying condition (via E10.-), E09 — Drug or chemical induced diabetes mellitus (via E10.-), E11 — Type 2 diabetes mellitus (via E10.-), E13 — Other specified diabetes mellitus (via E10.-), E74 — Other disorders of carbohydrate metabolism (via E10.-), E87.2 — Acidosis (via E10.-), G54.5 — Neuralgic amyotrophy (via E10.-), G59 — Mononeuropathy in diseases classified elsewhere (via E10.-), G63 — Polyneuropathy in diseases classified elsewhere (via E10.-), G99.0 — Autonomic neuropathy in diseases classified elsewhere (via E10.-), H20.0 — Acute and subacute iridocyclitis (via E10.-), H36 — Retinal disorders in diseases classified elsewhere (via E10.3.-), I73.8 — Other specified peripheral vascular diseases (via E10.-), I79.8 — Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere (via E10.-), L92.1 — Necrobiosis lipoidica, not elsewhere classified (via E10.-), L99 — Other disorders of skin and subcutaneous tissue in diseases classified elsewhere (via E10.-), M14 — Arthropathies in other diseases classified elsewhere (via E10.-), M14.6 — Charcôt's joint (via E10.-), M90 — Osteopathies in diseases classified elsewhere (via E10.-), N08 — Glomerular disorders in diseases classified elsewhere (via E10.-), +5 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 E10.-), I96 — Gangrene, not elsewhere classified (via E10.-).

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 E10.-).

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 E10.-).

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

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END004 — Diabetes mellitus, Type 1; 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, Type 1, Retinal and vitreous conditions).

E10.321 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, E10.3211 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye, E10.3212 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye, E10.3213 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral, E10.3219 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye, E10.329 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, E10.3291 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye, E10.3292 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye, E10.3293 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral, E10.3299 — Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye, E10.3311 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye, E10.3312 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye, E10.3313 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral, E10.3319 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye, E10.339 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, E10.3391 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye, E10.3392 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye, E10.3393 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral, E10.3399 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye, E10.341 — Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, +910 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Diabetes, diabetic”; these codes share that main term but sit in a different category of the Tabular List.

E09.622 — Drug or chemical induced diabetes mellitus with other skin ulcer (due to drug or chemical, with, skin ulcer NEC), E09.628 — Drug or chemical induced diabetes mellitus with other skin complications (due to drug or chemical, with, skin complication NEC), E09.630 — Drug or chemical induced diabetes mellitus with periodontal disease (due to drug or chemical, with, periodontal disease), E09.638 — Drug or chemical induced diabetes mellitus with other oral complications (due to drug or chemical, with, oral complication NEC), E09.641 — Drug or chemical induced diabetes mellitus with hypoglycemia with coma (due to drug or chemical, with, hypoglycemia, with coma), E09.649 — Drug or chemical induced diabetes mellitus with hypoglycemia without coma (due to drug or chemical, with, hypoglycemia), E09.65 — Drug or chemical induced diabetes mellitus with hyperglycemia (due to drug or chemical, with, hyperglycemia), E09.69 — Drug or chemical induced diabetes mellitus with other specified complication (due to drug or chemical, with, complication, specified NEC), E09.8 — Drug or chemical induced diabetes mellitus with unspecified complications (due to drug or chemical, with, complication), E09.9 — Drug or chemical induced diabetes mellitus without complications (due to drug or chemical), E11.00 — Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) (with, hyperosmolarity), E11.01 — Type 2 diabetes mellitus with hyperosmolarity with coma (with, hyperosmolarity, with coma), E11.1 — Type 2 diabetes mellitus with ketoacidosis (type 2, with, coma due to, ketoacidosis), E11.10 — Type 2 diabetes mellitus with ketoacidosis without coma (with, ketoacidosis), E11.11 — Type 2 diabetes mellitus with ketoacidosis with coma (with, ketoacidosis, with coma), E11.21 — Type 2 diabetes mellitus with diabetic nephropathy (with, nephropathy), E11.22 — Type 2 diabetes mellitus with diabetic chronic kidney disease (with, chronic kidney disease), E11.29 — Type 2 diabetes mellitus with other diabetic kidney complication (with, renal complication NEC), E11.311 — Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema (with, retinopathy, with macular edema), E11.319 — Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema (with, retinopathy), +190 more

Contextual Map

Every relationship of E10.331 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 E10.331 with these 12 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (25)

Referenced by Excludes2 notes

  • H35 — Other retinal disorders[Excludes2](via E10.-): “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 E10.-): “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)

Index entries

  • Diabetes, diabetic (mellitus) (sugar), type 1, with, retinopathy, nonproliferative, moderate, with macular edema[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (40)

Change history (2)

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.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

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.

Common coding questions

MedCoder editorial

Can E10.331 be billed directly?

No. E10.331 (Type 1 diabetes mellitus with moderate nonproliferative 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 E10.331 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E10.33 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
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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. "E10.331 — Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/e10.331-type-1-diabetes-mellitus-with-moderate-nonproliferative-diabetic-retinopathy-with-macular-edema

Change history

  • FY2017 — October 1, 2016
    Became a non-billable header
    FY2017 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E10.331 in its code family, with their registry titles.

View all codes in the E10 family