E11.37X1 ICD-10-CM Code: Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.
Inpatient Payment Groups (MS-DRG)
MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0 (FY2026), Appendix B.
- MS-DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)
- MS-DRG 010 — PANCREAS TRANSPLANT (MDC PRE)
- MS-DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)
- MS-DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)
- MS-DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)
A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.
Risk Adjustment (CMS-HCC)
Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.
- HCC 37 — Diabetes with Chronic Complications (supersedes HCC 38)
Other models: CMS-HCC V22 HCC 18 · RxHCC V08 HCC 30
Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.
Code Set: Valid FY2026 and FY2027. FY2026 took effect October 1, 2025.
Official Registry Overview & Definition
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for E11.37X1 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 that can never be reported with this code; the two are mutually exclusive.
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- postpancreatectomy diabetes mellitus (E13.-)
- postprocedural diabetes mellitus (E13.-)
- secondary diabetes mellitus NEC (E13.-)
- type 1 diabetes mellitus (E10.-)
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)
Frequently Asked Questions (FAQ) & Clinical Guidance
Does E11.37X1 require a 7th character?
Yes. One of the following 7th characters is to be assigned to code E11.37 to designate laterality of the disease:.
Nearest Codes in This Family
Official ICD-10-CM classifications closest to E11.37X1 in its code family, with their registry titles.
- E11.3592 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
- E11.3593 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
- E11.3599 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
- E11.36 — Type 2 diabetes mellitus with diabetic cataract
- E11.37 — Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment
- E11.37X2 — Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
- E11.37X3 — Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral
- E11.37X9 — Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
- E11.39 — Type 2 diabetes mellitus with other diabetic ophthalmic complication
- E11.4 — Type 2 diabetes mellitus with neurological complications