E09.319 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
E09.319 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E09.319
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDrug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
Diabetes caused by medications or chemicals with eye damage (retinopathy) of unspecified type without swelling in the macula.
Buddy Insight
Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema indicates retinal damage from drug-induced diabetes that has not been further characterized by stage and does not involve macular fluid accumulation.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
MappedHCC 20
Varies by metal level
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E09.319 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E09.319 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E09.319 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E09.319 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E09.319 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E09.319 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E09.319 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E09.319 an HCC code?
Yes. E09.319 maps to Diabetes with Chronic Complications under the V24 model but is not retained in V28.
- Code
- E09.319
- Description
- Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work E09.319 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E09.319
For E09.319 to 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 E09.319 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E09.319 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema. Diabetes caused by medications or chemicals with eye damage (retinopathy) of unspecified type without swelling in the macula. E09.319 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 older CMS-HCC V24 model, E09.319 maps to Diabetes with Chronic Complications (HCC 18) with a community, non-dual, aged base RAF weight of 0.302. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Distinguish this code from E09.311 by confirming absence of macular edema in documentation. Because E09.319 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for E09.319 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish this code from E09.311 by confirming absence of macular edema in documentation
- •Query provider if retinopathy type can be more specifically identified (nonproliferative vs. proliferative)
Clinical Significance
Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema indicates retinal damage from drug-induced diabetes that has not been further characterized by stage and does not involve macular fluid accumulation. While less immediately vision-threatening than cases with macular edema, diabetic retinopathy of any type signals progressive microvascular disease and requires regular ophthalmologic monitoring to prevent vision loss.
Documentation Requirements
- ✓The causative agent must be identified and coded.
- ✓Ophthalmologic documentation should confirm retinopathy is present and that macular edema is absent.
- ✓The provider should be queried to specify whether the retinopathy is nonproliferative (mild, moderate, severe) or proliferative, as this determines appropriate treatment and follow-up intervals.
Commonly Confused Codes
- •E09.311 (with macular edema) should be used if macular edema is present.
- •Stage-specific retinopathy codes (E09.321x-E09.359x) are preferred when the severity is documented.
- •E09.39 (other ophthalmic complication) applies to non-retinopathy eye conditions.
- •E08.319 and E10.319 are similar codes for different diabetes types.