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E11.355 ICD-10-CM Code: Type 2 diabetes mellitus with stable proliferative diabetic retinopathy

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 stable proliferative diabetic retinopathy is a non-billable ICD-10-CM category code (E11.355). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E11.355 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, proliferative, with, stable proliferative diabetic retinopathy
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, proliferative, with, stable proliferative diabetic retinopathy

Frequently Compared Codes

The official Excludes notes on E11.355 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Type 2 diabetes mellitus with stable proliferative diabetic retinopathy
    FY2017 changes

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

Official ICD-10-CM tabular notes on other codes that name E11.355 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 E11.355 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

Index entries

  • Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, proliferative, with, stable proliferative diabetic retinopathy[Index term]
  • Diabetes, diabetic (mellitus) (sugar), with, retinopathy, proliferative, with, stable proliferative diabetic retinopathy[Index term]

Nearest codes (40)

  • E11 — Type 2 diabetes mellitus [Sibling]
  • E11.351 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema [Sibling]
  • E11.3511 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye [Sibling]
  • E11.3512 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye [Sibling]
  • E11.3513 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral [Sibling]
  • E11.3519 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye [Sibling]
  • E11.352 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula [Sibling]
  • E11.3521 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E11.355 be billed directly?

No. E11.355 (Type 2 diabetes mellitus with stable proliferative diabetic retinopathy) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does E11.355 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E11.35 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E11.355 in its code family, with their registry titles.

  • E11.354 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment
  • E11.3541 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye
  • E11.3542 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye
  • E11.3543 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral
  • E11.3549 — Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye
  • E11.3551 — Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye
  • E11.3552 — Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye
  • E11.3553 — Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
  • E11.3559 — Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
  • E11.359 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema

View all codes in the E11 family