Skip to content
HCC Buddy home

E08.319 ICD-10-CM Code: Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema

E08.319 maps to CMS-HCC V28 37. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupE08.319

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E08.319

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema

Eye damage from diabetes caused by an underlying condition without swelling in the macula.

Buddy the Bee presenting code insight

Buddy Insight

Diabetes mellitus due to an underlying condition with unspecified diabetic retinopathy without macular edema indicates diabetic eye disease in secondary diabetes where the retinopathy stage has not been specified and the macula is not involved.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 37

Coefficient HCC 37: 0.166 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 020

Code-level coefficient reference

ESRD/PACE

HCC 18

Code-level coefficient reference

RXHCC

HCC 30

Code-level coefficient reference

Code Book Path

Official
E08.3Diabetes mellitus due to underlying condition with ophthalmic complicationsE08.31Diabetes mellitus due to underlying condition with unspecified diabetic retinopathyE08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema

Inclusion Terms

Official

No inclusion terms are included in this display for E08.319. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for E08.319. Check the code and parent instructions in the Code Book.

Related Codes

Official
E08.311Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema

Includes

Official

No Includes notes are included in this display for E08.319. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E08
  • drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E08
  • gestational diabetes (O24.4-)Inherited from E00-E89, E08
  • neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E08
  • postpancreatectomy diabetes mellitus (E13.-)Inherited from E00-E89, E08
  • postprocedural diabetes mellitus (E13.-)Inherited from E00-E89, E08
  • secondary diabetes mellitus NEC (E13.-)Inherited from E00-E89, E08
  • type 1 diabetes mellitus (E10.-)Inherited from E00-E89, E08
  • type 2 diabetes mellitus (E11.-)Inherited from E00-E89, E08

Code First

Official
  • the underlying condition, such as:Inherited from E08
  • congenital rubella (P35.0)Inherited from E08
  • Cushing's syndrome (E24.-)Inherited from E08
  • cystic fibrosis (E84.-)Inherited from E08
  • malignant neoplasm (C00-C96)Inherited from E08
  • malnutrition (E40-E46)Inherited from E08
  • pancreatitis and other diseases of the pancreas (K85-K86.-)Inherited from E08

Use Additional

Official
  • code to identify control using:Inherited from E08
  • injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E08
  • insulin (Z79.4)Inherited from E08
  • oral antidiabetic drugs (Z79.84)Inherited from E08
  • oral hypoglycemic drugs (Z79.84)Inherited from E08

Code Also

Official

No Code Also instructions are included in this display for E08.319. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Document the underlying condition causing diabetes, the presence of diabetic retinopathy on fundoscopic examination, explicit absence of macular edema, and laterality.
Query the ophthalmologist for the specific stage of retinopathy (nonproliferative mild/moderate/severe or proliferative) to enable more specific coding.
Record the frequency of follow-up eye examinations.

MEAT Support

HCC Buddy guidance
Document the underlying condition causing diabetes, the presence of diabetic retinopathy on fundoscopic examination, explicit absence of macular edema, and laterality.
Query the ophthalmologist for the specific stage of retinopathy (nonproliferative mild/moderate/severe or proliferative) to enable more specific coding.
Record the frequency of follow-up eye examinations.

Audit Caution

HCC Buddy guidance
The unspecified stage designation should trigger a query for retinopathy staging.
If the patient has both retinopathy and macular edema, use E08.311 instead.
Ensure the underlying causative condition is coded first in the sequencing.
Annual diabetic eye exam documentation supports medical necessity.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E08.319 an HCC code?

Yes. E08.319 (Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema) maps to HCC 37, Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.166. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: E08.319 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
E08.319
Description
Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
HCC (V28)
HCC 37 — Diabetes with Chronic Complications
RAF reference coefficient
0.166
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 37, Diabetes with Chronic Complications
0.166
ESRDHCC 18, Diabetes with Chronic Complications
Not separately weighted
RxHCCHCC 30, Diabetes with Complications
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E08.319 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E08.319

For E08.319, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

E08.319 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema. Eye damage from diabetes caused by an underlying condition without swelling in the macula. E08.319 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).

Under the CMS-HCC V28 risk adjustment model, E08.319 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code when retinopathy is present but macular edema is explicitly ruled out or not documented. For E08.319, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E08.319 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use this code when retinopathy is present but macular edema is explicitly ruled out or not documented
  • •Ensure the underlying condition is coded separately

Clinical Significance

Diabetes mellitus due to an underlying condition with unspecified diabetic retinopathy without macular edema indicates diabetic eye disease in secondary diabetes where the retinopathy stage has not been specified and the macula is not involved. While the absence of macular edema is favorable for central vision preservation, the unspecified retinopathy stage limits clinical utility and may indicate incomplete ophthalmologic evaluation. Regular dilated eye examinations are essential to monitor for progression.

Documentation Requirements

  • ✓Document the underlying condition causing diabetes, the presence of diabetic retinopathy on fundoscopic examination, explicit absence of macular edema, and laterality.
  • ✓Query the ophthalmologist for the specific stage of retinopathy (nonproliferative mild/moderate/severe or proliferative) to enable more specific coding.
  • ✓Record the frequency of follow-up eye examinations.

Child Codes

E08.311Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
HCC 37
E08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
HCC 37

Code Hierarchy

└E08Diabetes mellitus due to underlying condition└E08.3Diabetes mellitus due to underlying condition with ophthalmic complications└E08.31Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy└E08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
└E08.319Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema

Also searched as

  • E08 319
  • E08319

For E08.319, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

E08.319 maps to CMS-HCC V28 category 37, Diabetes with Chronic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for E08.319. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work E08.319 in HCC Buddy

Open E08.319 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

Open in Code BookOpen in EncoderStart Pro