E09.3419 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye

E09.3419 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye. E09.3419 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).

E09.3419 has no mapping under the CMS-HCC V28 or V24 community payment models. E09.3419 has a separate mapping under the CMS-HCC ESRD model (HCC 18 (Diabetes with Chronic Complications)) and the Part D RxHCC model (HCC 30 (Diabetes with Complications)); the applicable result needs member context. E09.3419 also appears in the HHS-HCC commercial risk model (HCC 020 (HHS-HCC 020 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

E09.3419 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models. It does map under the CMS-HCC ESRD model, the Part D RxHCC model and the HHS-HCC commercial model, and that result depends on member context rather than on the V28 community model. Do not assign risk adjustment value from this page when no source-backed mapping is shown. Coders should check the current model files and select only the specificity supported by the provider documentation.