What is ICD-10 code E09.36?

E09.36 is the ICD-10-CM diagnosis code for Drug or chemical induced diabetes mellitus with diabetic cataract. Diabetes caused by medications or chemicals that has caused clouding of the eye lens (cataract). It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E09.36 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E09.36 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.

Yes. E09.36 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. E09.36 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 E09.36?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. E09.36 was a payment HCC under V24 (Diabetes with Chronic Complications) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting E09.36?

Document whether the cataract is unilateral or bilateral for complete clinical documentation Verify the cataract is related to the drug-induced diabetes rather than another cause Because E09.36 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM E09.36: Drug or chemical induced

ICD-10-CM Code View

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Code lookupE09.36Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

E09.36

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

Drug or chemical induced diabetes mellitus with diabetic cataract

Diabetes caused by medications or chemicals that has caused clouding of the eye lens (cataract).

Buddy Insight

Drug or chemical induced diabetes mellitus with diabetic cataract indicates lens opacification directly attributable to drug-induced diabetes.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.302

ACA/HHS

Mapped

HCC 20

HHS-HCC 20

Varies by metal level

ESRD/PACE

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.084

RXHCC

Mapped

HCC 30

Diabetes with Complications

RAF 0.495

Code Book Path

Official

E09Drug or chemical induced diabetes mellitus

E09.3Drug or chemical induced diabetes mellitus with ophthalmic complications

E09.36Drug or chemical induced diabetes mellitus with diabetic cataract

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E09.36 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E09.36 in this effective period.

Related Child Codes

Official

E09.31Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy

E09.32Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy

E09.33Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy

E09.34Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy

E09.35Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy

Includes

Official

ICD-10-CM does not list Includes notes for E09.36 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E09.36 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E09.36 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E09.36 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E09.36 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

The causative drug or chemical must be documented and coded separately.

The provider must establish a causal link between the diabetes and the cataract, distinguishing it from age-related or other causes of lens opacity.

Ophthalmologic examination findings including visual acuity and lens examination results should be documented.

MEAT Support

HCC Buddy guidance

The causative drug or chemical must be documented and coded separately.

The provider must establish a causal link between the diabetes and the cataract, distinguishing it from age-related or other causes of lens opacity.

Ophthalmologic examination findings including visual acuity and lens examination results should be documented.

Audit Caution

HCC Buddy guidance

Attributing cataracts to diabetes requires provider documentation of the causal relationship

cataracts in a diabetic patient are not automatically diabetic cataracts. If the patient also has retinopathy, both conditions should be coded separately. Do not assume drug-induced diabetes when the patient has concurrent Type 2 diabetes.

Common Mistakes

HCC Buddy guidance

H25 (age-related cataract) should not be used when the cataract is attributable to diabetes.

E09.39 (other ophthalmic complication) should not be used for cataracts, as E09.36 is the specific code.

E10.36 and E11.36 are the corresponding codes for Type 1 and Type 2 diabetes, respectively.

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 E09.36 an HCC code?

Yes. E09.36 maps to Diabetes with Chronic Complications under the V24 model but is not retained in V28.

Code: E09.36
Description: Drug or chemical induced diabetes mellitus with diabetic cataract
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 18, Diabetes with Chronic Complications

0.302

ESRDHCC 18, Diabetes with Chronic Complications

0.084

RxHCCHCC 30, Diabetes with Complications

0.495

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 E09.36 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E09.36

For E09.36 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 E09.36 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E09.36 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with diabetic cataract. Diabetes caused by medications or chemicals that has caused clouding of the eye lens (cataract). E09.36 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, E09.36 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.

Document whether the cataract is unilateral or bilateral for complete clinical documentation. Because E09.36 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 E09.36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document whether the cataract is unilateral or bilateral for complete clinical documentation
•Verify the cataract is related to the drug-induced diabetes rather than another cause

Clinical Significance

Drug or chemical induced diabetes mellitus with diabetic cataract indicates lens opacification directly attributable to drug-induced diabetes. Diabetic cataracts develop due to osmotic lens changes from chronic hyperglycemia, causing sorbitol accumulation within the lens fibers. These cataracts may develop more rapidly and at younger ages than typical age-related cataracts, and surgical intervention is often required to restore functional vision.

Documentation Requirements

✓The causative drug or chemical must be documented and coded separately.
✓The provider must establish a causal link between the diabetes and the cataract, distinguishing it from age-related or other causes of lens opacity.
✓Ophthalmologic examination findings including visual acuity and lens examination results should be documented.

Commonly Confused Codes

•H25 (age-related cataract) should not be used when the cataract is attributable to diabetes.
•E09.39 (other ophthalmic complication) should not be used for cataracts, as E09.36 is the specific code.
•E10.36 and E11.36 are the corresponding codes for Type 1 and Type 2 diabetes, respectively.