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E11.331 ICD-10-CM Code: Type 2 diabetes mellitus with moderate 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 moderate nonproliferative diabetic retinopathy with macular edema is a non-billable ICD-10-CM category code (E11.331). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E11.331 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 (2)

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, moderate, with macular edema
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, nonproliferative, moderate, with macular edema

Frequently Compared Codes

The official Excludes notes on E11.331 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.

Referenced by Other Codes

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.

Official ICD-10-CM tabular notes on other codes that name E11.331 or its code family.

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

Contextual Map

Every relationship of E11.331 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.

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

Nearest codes (40)

  • E11 — Type 2 diabetes mellitus [Sibling]
  • E11.2 — Type 2 diabetes mellitus with kidney complications [Sibling]
  • E11.21 — Type 2 diabetes mellitus with diabetic nephropathy [Sibling]
  • E11.22 — Type 2 diabetes mellitus with diabetic chronic kidney disease [Sibling]
  • E11.29 — Type 2 diabetes mellitus with other diabetic kidney complication [Sibling]
  • E11.3 — Type 2 diabetes mellitus with ophthalmic complications [Sibling]
  • E11.31 — Type 2 diabetes mellitus with unspecified diabetic retinopathy [Sibling]
  • E11.311 — Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema [Sibling]
  • and 32 more

Change history

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

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E11.331 be billed directly?

No. E11.331 (Type 2 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 E11.331 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E11.33 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E11.331 in its code family, with their registry titles.

  • E11.3291 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
  • E11.3292 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
  • E11.3293 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
  • E11.3299 — Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye
  • E11.33 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
  • E11.3311 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
  • E11.3312 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye
  • E11.3313 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
  • E11.3319 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye
  • E11.339 — Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema

View all codes in the E11 family