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ICD-10/E13.37X3

E13.37X3 ICD-10-CM Code: Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral

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 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 diabetic macular edema, resolved following treatment, bilateral is a billable ICD-10-CM diagnosis code (E13.373).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for E13.37X3 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 diabetic macular edema, resolved following treatment, bilateral
    FY2017 changes

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 E13.37X3 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]

Risk adjustment (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]
  • E13.3539 — Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye [Sibling]
  • E13.354 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment [Sibling]
  • E13.3541 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye [Sibling]
  • E13.3542 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye [Sibling]
  • E13.3543 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral [Sibling]
  • E13.3549 — Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye [Sibling]
  • E13.355 — Other specified diabetes mellitus with stable proliferative diabetic retinopathy [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).

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 E13.37X3 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 E13.37X3 require a 7th character?

Yes. One of the following 7th characters is to be assigned to code E13.37 to designate laterality of the disease:.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to E13.37X3 in its code family, with their registry titles.

  • E13.3599 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
  • E13.36 — Other specified diabetes mellitus with diabetic cataract
  • E13.37 — Other specified diabetes mellitus with diabetic macular edema, resolved following treatment
  • E13.37X1 — Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye
  • E13.37X2 — Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye
  • E13.37X9 — Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye
  • E13.39 — Other specified diabetes mellitus with other diabetic ophthalmic complication
  • E13.4 — Other specified diabetes mellitus with neurological complications
  • E13.40 — Other specified diabetes mellitus with diabetic neuropathy, unspecified
  • E13.41 — Other specified diabetes mellitus with diabetic mononeuropathy

View all codes in the E13 family