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E11.321 ICD-10-CM Code: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema

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

Official Registry Overview & Definition

Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema is a non-billable ICD-10-CM category code (E11.321). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E11.321 in the official ICD-10-CM tabular list.

Includes

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

  • diabetes (mellitus) due to insulin secretory defect
  • diabetes NOS
  • insulin resistant diabetes (mellitus)

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).

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)

Indexed Clinical Terms (4)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, nonproliferative, mild, with macular edema
  • Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, nonproliferative, with macular edema
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, nonproliferative, mild, with macular edema
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, nonproliferative, with macular edema

Frequently Compared Codes

The official Excludes notes on E11.321 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

Verify Before Coding

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

Relationships & Classification

Other codes that name E11.321 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.

4 Excludes1 notes across 2 chapters: E08 (via E11.-), E09 (via E11.-), E10 (via E11.-), H36 (via E11.3.-).

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END005 — Diabetes mellitus, Type 2; 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 2, Retinal and vitreous conditions).

E11.21 — Type 2 diabetes mellitus with diabetic nephropathy, E11.22 — Type 2 diabetes mellitus with diabetic chronic kidney disease, E11.29 — Type 2 diabetes mellitus with other diabetic kidney complication, E11.311 — Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, E11.319 — Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, E11.3211 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye, E11.3212 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye, E11.3213 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral, E11.3219 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye, E11.329 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, +918 more

Contextual Map

Every relationship of E11.321 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 E11.-): “type 2 diabetes mellitus (E11.-)” · check together
  • E09 — Drug or chemical induced diabetes mellitus [Excludes1](via E11.-): “type 2 diabetes mellitus (E11.-)” · check together
  • E10 — Type 1 diabetes mellitus [Excludes1](via E11.-): “type 2 diabetes mellitus (E11.-)” · check together
  • H36 — Retinal disorders in diseases classified elsewhere [Excludes1](via E11.3.-): “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)” · check together

Clinical classification (CCSR)

  • END003 — Diabetes mellitus with complication [CCSR]
  • END005 — Diabetes mellitus, Type 2 [CCSR]
  • EYE005 — Retinal and vitreous conditions [CCSR]

Index entries

  • Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, nonproliferative, mild, with macular edema[Index term]
  • Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, nonproliferative, with macular edema[Index term]
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, nonproliferative, mild, with macular edema[Index term]
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, nonproliferative, with macular edema[Index term]

Nearest codes (40)

  • E11 — Type 2 diabetes mellitus [Sibling]
  • E11.0 — Type 2 diabetes mellitus with hyperosmolarity [Sibling]
  • E11.00 — Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) [Sibling]
  • E11.01 — Type 2 diabetes mellitus with hyperosmolarity with coma [Sibling]
  • E11.1 — Type 2 diabetes mellitus with ketoacidosis [Sibling]
  • E11.10 — Type 2 diabetes mellitus with ketoacidosis without coma [Sibling]
  • E11.11 — Type 2 diabetes mellitus with ketoacidosis with coma [Sibling]
  • E11.2 — Type 2 diabetes mellitus with kidney complications [Sibling]
  • and 32 more

Change history

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

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E11.321 be billed directly?

No. E11.321 (Type 2 diabetes mellitus with mild 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 E11.321 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E11.32 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E11.321 in its code family, with their registry titles.

  • E11.3 — Type 2 diabetes mellitus with ophthalmic complications
  • E11.31 — Type 2 diabetes mellitus with unspecified diabetic retinopathy
  • E11.311 — Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
  • E11.319 — Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
  • E11.32 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
  • E11.3211 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
  • E11.3212 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
  • E11.3213 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
  • E11.3219 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
  • E11.329 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema

View all codes in the E11 family