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E08.351 ICD-10-CM Code: Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema

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

E08.351

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema

Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
E08.3Diabetes mellitus due to underlying condition with ophthalmic complications
E08.35Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy
E08.351Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E08.351 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E08.351 in this effective period.

Related Child Codes

Official
E08.3511Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye
E08.3512Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye
E08.3513Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral
E08.3519Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye

Includes

Official

ICD-10-CM does not list Includes notes for E08.351 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E08.351 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E08.351 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E08.351 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E08.351 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

E08.351 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema. E08.351 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).

Header codes like E08.351 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at E08.351's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E08.351 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

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