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ICD-10-CM 2027 diagnosis code

E13.311Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema

✓ Billable / specific

E13.311 is a valid, billable ICD-10-CM code for other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.Short description: Oth diabetes w unsp diabetic retinopathy w macular edema

Code unchanged since ICD-10-CM took effect on October 1, 2015. Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data

About E13.311

E13.311 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema. It belongs to category E13 (other specified diabetes mellitus), block E08-E13 (diabetes mellitus) and chapter 4 (endocrine, nutritional and metabolic diseases). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within E13.31 (other specified diabetes mellitus with unspecified diabetic retinopathy), E13.311 is specifically for other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema. Related codes cover without macular edema (E13.319).

Use an additional code to identify control using: injectable non-insulin antidiabetic drugs (Z79.85), insulin (Z79.4), oral antidiabetic drugs (Z79.84) and oral hypoglycemic drugs (Z79.84).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 008 (Simultaneous Pancreas, Islet Cell and Kidney Transplant, relative weight 5.5146), DRG 010 (Pancreas or Islet Cell Transplant, relative weight 7.5259), DRG 019 (Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis, relative weight 7.5493), DRG 124 (Other Disorders of the Eye with MCC or Thrombolytic Agent, relative weight 1.2471) and DRG 125 (Other Disorders of the Eye without MCC, relative weight 0.7702), in Pre-MDC and MDC 02 (Diseases and Disorders of the Eye), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as 249.50 (secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecified), 250.50 (diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled), 362.01 (background diabetic retinopathy) and 1 more.

Notes that apply from higher levels

Instructions written at a parent level also apply to E13.311.

› From E13 Other specified diabetes mellitus
Includes
  • 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
  • diabetes (mellitus) due to autoimmune process (E10.-)
  • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
  • diabetes mellitus due to underlying condition (E08.-)
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • neonatal diabetes mellitus (P70.2)
  • type 1 diabetes mellitus (E10.-)
Use additional code
  • 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)

Broader instructions also apply from Chapter 4: Endocrine, nutritional and metabolic diseases.

Alphabetic index entries

1 entries

Terms in the official ICD-10-CM index that lead to E13.311.

Codes whose notes reference E13.311

MS-DRG v44.0 grouping

All DRGs →

Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.

ICD-9-CM equivalent

Converter →
  • 249.50Secondary diabetes mellitus with ophthalmic manifestations, not stated as uncontrolled, or unspecifiedapproximate, combination
  • 250.50Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolledapproximate, combination
  • 362.01Background diabetic retinopathyapproximate, combination
  • 362.07Diabetic macular edemaapproximate, combination

From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.

Code history

  1. 2016
  2. 2017
  3. 2018
  4. 2019
  5. 2020
  6. 2021
  7. 2022
  8. 2023
  9. 2024
  10. 2025
  11. 2026
  12. 2027
  • FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
  • No changes since FY2016.

Common questions about E13.311

Is E13.311 billable?

Yes. E13.311 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).

Can E13.311 be used as a principal diagnosis?

Yes. The Medicare Code Editor doesn't restrict E13.311 as a principal diagnosis.

Is E13.311 a CC or MCC?

No. E13.311 is neither a CC nor an MCC under MS-DRG v44.0.

What DRG does E13.311 group to?

E13.311 is used in the MS-DRG v44.0 logic for MS-DRG 008 (Simultaneous Pancreas, Islet Cell and Kidney Transplant), MS-DRG 010 (Pancreas or Islet Cell Transplant), MS-DRG 019 (Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis), MS-DRG 124 (Other Disorders of the Eye with MCC or Thrombolytic Agent) and MS-DRG 125 (Other Disorders of the Eye without MCC). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.

What is the ICD-9 code for E13.311?

The CMS General Equivalence Mappings map E13.311 to ICD-9-CM 249.50, 250.50, 362.01 and 362.07.