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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.

Coding at a Glance

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E13.359 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on E13.359 itself; “inherited from” names the category or block whose note applies here.

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

Source: inherited from E13

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).

Source: inherited from E13

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)

Source: inherited from E13

7th Character Guide

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

  • 1 — right eye
  • 2 — left eye
  • 3 — bilateral
  • 9 — unspecified eye

Variant codes in this family

E13.3591, E13.3592, E13.3593, E13.3599

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for E13.359

MedCoder structured workflow — derived from this code’s own official record

Before you code E13.359

  1. E13.359 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewE13.3591, E13.3592, E13.3593, E13.3599

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on E13.359; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  3. A 7th character is required in this family. Confirm the documentation supports the character assigned — its meaning in this family is defined in the official instruction. E13.359 is not valid without one. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  4. Confirm the documented diabetes type or cause (the E08–E13 categories are separated by it) and every documented complication or manifestation; the code is built from the type first and the complication second. Then work the category’s Use Additional Code notes for medication and control status. Type 2 is the default only when the type is not documented, and insulin or other medication use does not by itself establish the type (Guidelines I.C.4.a.2, I.C.4.a.3).

    Guide: Secondary diabetes (E08, E09, E13) →

  5. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E13.359. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support one of the more specific codes beneath E13.359?
    Yes → Select that code and continue the checks below on its own page.
    No → E13.359 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewE13.3591, E13.3592, E13.3593, E13.3599

  2. Does the documentation support a condition named in E13.359’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewE10, E08, E09, O24.4, P70.2

  3. Does the documentation support one of this family’s 7th-character values?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider E13.359. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Diabetes type or cause, each complication, and medication use
The type is documented, not inferred from medication (Guidelines I.C.4.a.3); each documented complication takes its own combination code.
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting E13.359(7 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E13.359: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareE10, E08, E09, O24.4, P70.2

    See the official tabular notes · Guidelines I.A.12.a

  • Use Additional Code — after identifying E13.359(5 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with E13.359 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewZ79.85, Z79.4, Z79.84

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E13.359 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewE10, E08, E09, O24.4, P70.2

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with E13.359?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewZ79.85, Z79.4, Z79.84

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

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.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. 5 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 7 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

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

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name E13.359 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 23 Excludes1 notes across 8 chapters: E08 — Diabetes mellitus due to underlying condition (via E13.-), E09 — Drug or chemical induced diabetes mellitus (via E13.-), E10 — Type 1 diabetes mellitus (via E13.-), E11 — Type 2 diabetes mellitus (via E13.-), E74 — Other disorders of carbohydrate metabolism (via E13.-), G54.5 — Neuralgic amyotrophy (via E13.-), G59 — Mononeuropathy in diseases classified elsewhere (via E13.-), G63 — Polyneuropathy in diseases classified elsewhere (via E13.-), G99.0 — Autonomic neuropathy in diseases classified elsewhere (via E13.-), H20.0 — Acute and subacute iridocyclitis (via E13.-), H36 — Retinal disorders in diseases classified elsewhere (via E13.3.-), I73.8 — Other specified peripheral vascular diseases (via E13.-), I79.8 — Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere (via E13.-), L92.1 — Necrobiosis lipoidica, not elsewhere classified (via E13.-), L99 — Other disorders of skin and subcutaneous tissue in diseases classified elsewhere (via E13.-), M14 — Arthropathies in other diseases classified elsewhere (via E13.-), M14.6 — Charcôt's joint (via E13.-), M90 — Osteopathies in diseases classified elsewhere (via E13.-), N08 — Glomerular disorders in diseases classified elsewhere (via E13.-), N16 — Renal tubulo-interstitial disorders in diseases classified elsewhere (via E13.-), +3 more.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes across 2 chapters: H35 — Other retinal disorders (via E13.-), I96 — Gangrene, not elsewhere classified (via E13.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Code First instructions across 2 chapters: D84.81 — Immunodeficiency due to conditions classified elsewhere (via E13.-), E89.1 — Postprocedural hypoinsulinemia (via E13.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Use Additional Code instruction: Z90.41 — Acquired absence of pancreas (via E13.-).

These codes instruct coders to additionally report this code when it applies.

Referenced by 1 Code Also instruction: N76.82 — Fournier disease of vagina and vulva (via E13.-).

These codes suggest coding this condition alongside when both are present.

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.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Diabetes mellitus with complication, Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type, Retinal and vitreous conditions).

E13.3533 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral, E13.3539 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye, E13.3541 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye, E13.3542 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye, E13.3543 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral, E13.3549 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye, 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, E13.39 — Other specified diabetes mellitus with other diabetic ophthalmic complication, E13.40 — Other specified diabetes mellitus with diabetic neuropathy, unspecified, E13.41 — Other specified diabetes mellitus with diabetic mononeuropathy, E13.42 — Other specified diabetes mellitus with diabetic polyneuropathy, E13.43 — Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy, +903 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Diabetes, diabetic”; these codes share that main term but sit in a different category of the Tabular List.

E11.628 — Type 2 diabetes mellitus with other skin complications (with, skin complication NEC), E11.630 — Type 2 diabetes mellitus with periodontal disease (with, periodontal disease), E11.638 — Type 2 diabetes mellitus with other oral complications (with, oral complication NEC), E11.641 — Type 2 diabetes mellitus with hypoglycemia with coma (with, hypoglycemia, with coma), E11.649 — Type 2 diabetes mellitus with hypoglycemia without coma (with, hypoglycemia), E11.65 — Type 2 diabetes mellitus with hyperglycemia (with, hyperglycemia), E11.69 — Type 2 diabetes mellitus with other specified complication (with, osteomyelitis), E11.8 — Type 2 diabetes mellitus with unspecified complications (with, complication), E11.9 — Type 2 diabetes mellitus without complications, E11.A — Type 2 diabetes mellitus without complications in remission (without complications in remission), E23.2 — Diabetes insipidus (insipidus), E83.110 — Hereditary hemochromatosis (bronzed), E83.39 — Other disorders of phosphorus metabolism (phosphate), N25.1 — Nephrogenic diabetes insipidus (insipidus, nephrogenic), O24.410 — Gestational diabetes mellitus in pregnancy, diet controlled (gestational, diet controlled), O24.414 — Gestational diabetes mellitus in pregnancy, insulin controlled (gestational, insulincontrolled), O24.415 — Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs (gestational, oral drug controlled), O24.419 — Gestational diabetes mellitus in pregnancy, unspecified control (gestational), O24.420 — Gestational diabetes mellitus in childbirth, diet controlled (gestational, in childbirth, diet controlled), O24.424 — Gestational diabetes mellitus in childbirth, insulin controlled (gestational, in childbirth, insulincontrolled), +192 more

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.

Run E13.359 with these 14 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (23)

Referenced by Excludes2 notes

  • H35 — Other retinal disorders[Excludes2](via E13.-): “diabetic retinal disorders (E08.311-E08.359, E09.311-E09.359, E10.311-E10.359, E11.311-E11.359, E13.311-E13.359)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • I96 — Gangrene, not elsewhere classified[Excludes2](via E13.-): “gangrene in diabetes mellitus (E08-E13 with .52)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

Referenced by Use Additional Code instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

Index entries

  • Diabetes, diabetic (mellitus) (sugar), specified type NEC, with, retinopathy, proliferative[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history (2)

Common coding questions

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:.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E13.359 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/e13.359-other-specified-diabetes-mellitus-with-proliferative-diabetic-retinopathy-without-macular-edema

Change history

  • FY2017 — October 1, 2016
    Became a non-billable header
    FY2017 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema

Nearest Codes in This Family

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

View all codes in the E13 family