What is ICD-10 code E08.3511?

E08.3511 is the ICD-10-CM diagnosis code for Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E08.3511 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E08.3511 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Is E08.3511 billable?

Yes. E08.3511 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E08.3511 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for E08.3511?

E08.3511 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards E08.3511 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

E08.3511 ICD-10 Code: Diabetes mellitus due

ICD-10-CM Code View

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Code lookupE08.3511Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

E08.3511

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

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

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 30

Diabetes with Complications

RAF 0.0

Code Trumping

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Code Book Path

Official

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

E08.3511Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E08.3511 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E08.3511 in this effective period.

Related Child Codes

Official

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 E08.3511 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E08.3511 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E08.3511 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E08.3511 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E08.3511 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.

Is E08.3511 an HCC code?

No. E08.3511 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 30, Diabetes with Complications

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for E08.3511

For E08.3511to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

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

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E08.3511 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

E08.3511 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye. E08.3511 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).

E08.3511 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

E08.3511 is a billable ICD-10-CM code that can be reported on claims but does not currently contribute to a Medicare Advantage member's RAF score under any CMS risk adjustment model (V28, V24, ESRD, or RxHCC). Coders reviewing E08.3511 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E08.3511 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.