FY2027 ICD-10-CM reference
E08.3523: Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Instructional note
All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
Source: E00-E89 (chapter, inherited).
Excludes1
transitory endocrine and metabolic disorders specific to newborn (P70-P74)
Source: E00-E89 (chapter, inherited).
Code first
the underlying condition, such as:
Source: E08 (category, inherited).
Code first
congenital rubella (P35.0)
Source: E08 (category, inherited).
Code first
Cushing's syndrome (E24.-)
Source: E08 (category, inherited).
Code first
cystic fibrosis (E84.-)
Source: E08 (category, inherited).
Code first
malignant neoplasm (C00-C96)
Source: E08 (category, inherited).
Code first
malnutrition (E40-E46)
Source: E08 (category, inherited).
Code first
pancreatitis and other diseases of the pancreas (K85-K86.-)
Source: E08 (category, inherited).
Instructional note
code to identify control using:
Source: E08 (category, inherited).
Instructional note
injectable non-insulin antidiabetic drugs (Z79.85)
Source: E08 (category, inherited).
Instructional note
insulin (Z79.4)
Source: E08 (category, inherited).
Instructional note
oral antidiabetic drugs (Z79.84)
Source: E08 (category, inherited).
Instructional note
oral hypoglycemic drugs (Z79.84)
Source: E08 (category, inherited).
Excludes1
drug or chemical induced diabetes mellitus (E09.-)
Source: E08 (category, inherited).
Excludes1
gestational diabetes (O24.4-)
Source: E08 (category, inherited).
Excludes1
neonatal diabetes mellitus (P70.2)
Source: E08 (category, inherited).
Excludes1
postpancreatectomy diabetes mellitus (E13.-)
Source: E08 (category, inherited).
Excludes1
postprocedural diabetes mellitus (E13.-)
Source: E08 (category, inherited).
Excludes1
secondary diabetes mellitus NEC (E13.-)
Source: E08 (category, inherited).
Excludes1
type 1 diabetes mellitus (E10.-)
Source: E08 (category, inherited).
Excludes1
type 2 diabetes mellitus (E11.-)
Source: E08 (category, inherited).
Seventh-character instruction
One of the following 7th characters is to be assigned to codes in subcategory E08.35 to designate laterality of the disease:
Source: E08.35 (self, inherited).
Instructional note
right eye
Source: E08.35 (self, inherited).
Instructional note
left eye
Source: E08.35 (self, inherited).
Instructional note
bilateral
Source: E08.35 (self, inherited).
Instructional note
unspecified eye
Source: E08.35 (self, inherited).
Seventh-character definitions
- 1: right eye
- 2: left eye
- 3: bilateral
- 9: unspecified eye
Compare the FY2027 additions, removals and billable-status changes
What does E08.3523 mean in FY2027?
The official ICD-10-CM descriptor is Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is E08.3523 billable in FY2027?
The FY2027 order file marks E08.3523 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does E08.3523 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), E08.3523 maps to CMS-HCC V28 HCC 37 (Diabetes with Chronic Complications) and HCC 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 18 and HCC 122; RxHCC HCC 30. Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24, PACE and HHS-HCC mappings are still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Read the FY2027 Official Guidelines.
Review the FY2026 April edition