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E09.355 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy

E09.355 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)

E09.355

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

Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy

Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
E09.3Drug or chemical induced diabetes mellitus with ophthalmic complications
E09.35Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy
E09.355Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E09.355 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E09.355 in this effective period.

Related Child Codes

Official
E09.3551Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye
E09.3552Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye
E09.3553Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral
E09.3559Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye

Includes

Official

ICD-10-CM does not list Includes notes for E09.355 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E09.355 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E09.355 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E09.355 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E09.355 in this effective period.

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 →

Code
E09.355
Description
Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

E09.355 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy. E09.355 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 E09.355 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 E09.355'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 E09.355 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

E09.355 code history

Code setChange
FY2017 (effective Oct 1, 2016)Added to the code set

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Work E09.355 in HCC Buddy

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