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E13.359 ICD-10-CM Code: Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema

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

Official Registry Overview & Definition

Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema is a non-billable ICD-10-CM category code (E13.359). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E13.359 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)

Indexed Clinical Terms (1)

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

  • Diabetes, diabetic (mellitus) (sugar), specified type NEC, with, retinopathy, proliferative

Frequently Compared Codes

The official Excludes notes on E13.359 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); 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.

Official ICD-10-CM tabular notes on other codes that name E13.359 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 Excludes2 notes: H35.

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

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

Contextual Map

Every relationship of E13.359 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 Excludes2 notes

  • H35 — Other retinal disorders [Excludes2]: “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)” · 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]

Index entries

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

Nearest codes (40)

  • E13 — Other specified diabetes mellitus [Sibling]
  • E13.352 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula [Sibling]
  • E13.3521 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye [Sibling]
  • E13.3522 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye [Sibling]
  • E13.3523 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral [Sibling]
  • E13.3529 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye [Sibling]
  • E13.353 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula [Sibling]
  • E13.3531 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye [Sibling]
  • and 32 more

Change history

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

Frequently Asked Questions (FAQ) & Clinical Guidance

Can E13.359 be billed directly?

No. E13.359 (Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does E13.359 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory E13.35 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E13.359 in its code family, with their registry titles.

  • E13.355 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy
  • E13.3551 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye
  • E13.3552 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye
  • E13.3553 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
  • E13.3559 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye
  • E13.3591 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
  • E13.3592 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
  • E13.3593 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
  • E13.3599 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
  • E13.36 — Other specified diabetes mellitus with diabetic cataract

View all codes in the E13 family