Skip to main content
ICD-10/E13.3212

E13.3212 ICD-10-CM Code: Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left 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, 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 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
  • 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.

Official Registry Overview & Definition

Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye is a billable ICD-10-CM diagnosis code (E13.3212).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E13.3212 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 genetic defects of beta-cell function
  • diabetes mellitus due to genetic defects in insulin action
  • postpancreatectomy diabetes mellitus
  • postprocedural diabetes mellitus
  • secondary diabetes mellitus NEC

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)

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
    FY2017 changes

Verify Before Coding

  • Billable — reportable as written.

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

Contextual Map

Every relationship of E13.3212 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 E13.-): “postpancreatectomy diabetes mellitus (E13.-)” · check together
  • E09 — Drug or chemical induced diabetes mellitus [Excludes1](via E13.-): “postpancreatectomy diabetes mellitus (E13.-)” · check together
  • E10 — Type 1 diabetes mellitus [Excludes1](via E13.-): “postpancreatectomy diabetes mellitus (E13.-)” · check together
  • E11 — Type 2 diabetes mellitus [Excludes1](via E13.-): “postpancreatectomy diabetes mellitus (E13.-)” · check together
  • H36 — Retinal disorders in diseases classified elsewhere [Excludes1](via E13.3.-): “diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)” · check together

Referenced by Code First instructions

  • E89.1 — Postprocedural hypoinsulinemia [Code First](via E13.-): “, if applicable, diabetes mellitus (postpancreatectomy) (postprocedural) (E13.-)” · check together

Referenced by Use Additional Code instructions

  • Z90.41 — Acquired absence of pancreas [Use Additional Code](via E13.-): “diabetes mellitus, postpancreatectomy (E13.-)” · check together

Clinical classification (CCSR)

  • END003 — Diabetes mellitus with complication [CCSR]
  • END006 — Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type [CCSR]
  • EYE005 — Retinal and vitreous conditions [CCSR]

Risk adjustment (CMS-HCC)

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]
  • HCC 37 — Diabetes with Chronic Complications [CMS-HCC]: “Diabetes with Chronic Complications — supersedes HCC 38 (Diabetes with Glycemic, Unspecified, or No Complications)”

Potential MS-DRG

  • DRG 008 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT (MDC PRE)”
  • DRG 010 — PANCREAS TRANSPLANT [MS-DRG]: “PANCREAS TRANSPLANT (MDC PRE)”
  • DRG 019 — SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS [MS-DRG]: “SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS (MDC PRE)”
  • DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT [MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”
  • DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC [MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”

MDC crossing · procedures (1353)

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 02 — Diseases and Disorders of the Eye [MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 02HA0QZ — Insertion of Implantable Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA0RZ — Insertion of Short-term External Heart Assist System into Heart, Open Approach [Same-MDC procedure]: “Insertion of Short-term External Heart Assist System into Heart, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA3QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02HA4QZ — Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Insertion of Implantable Heart Assist System into Heart, Percutaneous Endoscopic Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • 02RA0LZ — Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach [Same-MDC procedure]: “Replacement of Heart with Biologic and Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach — grouped in MDC PRE, the procedure side of this code's crossing.” · check together
  • and 1348 more

Nearest codes (40)

  • E13 — Other specified diabetes mellitus [Sibling]
  • E13.0 — Other specified diabetes mellitus with hyperosmolarity [Sibling]
  • E13.00 — Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) [Sibling]
  • E13.01 — Other specified diabetes mellitus with hyperosmolarity with coma [Sibling]
  • E13.1 — Other specified diabetes mellitus with ketoacidosis [Sibling]
  • E13.10 — Other specified diabetes mellitus with ketoacidosis without coma [Sibling]
  • E13.11 — Other specified diabetes mellitus with ketoacidosis with coma [Sibling]
  • E13.2 — Other specified diabetes mellitus with kidney complications [Sibling]
  • and 32 more

Change history

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

Referenced by Other Codes

Clinical classification (AHRQ CCSR):END003 — Diabetes mellitus with complication (default); END006 — Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type; 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.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 5 MS-DRGs: DRG 008 (MDC PRE), DRG 010 (MDC PRE), DRG 019 (MDC PRE), DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name E13.3212 or its code family.

5 Excludes1 notes across 2 chapters: E08 (via E13.-), E09 (via E13.-), E10 (via E13.-), E11 (via E13.-), H36 (via E13.3.-).

1 Code First instructions: E89.1 (via E13.-).

1 Use Additional Code instructions: Z90.41 (via E13.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does E13.3212 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E13.32 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E13.3212 in its code family, with their registry titles.

  • E13.311 — Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema
  • E13.319 — Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema
  • E13.32 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy
  • E13.321 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
  • E13.3211 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye
  • E13.3213 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
  • E13.3219 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
  • E13.329 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
  • E13.3291 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
  • E13.3292 — Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye

View all codes in the E13 family