E09.39 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication
E09.39 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E09.39
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDrug or chemical induced diabetes mellitus with other diabetic ophthalmic complication
Diabetes caused by medications or chemicals with eye complications other than retinopathy or cataract.
Buddy Insight
Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication captures eye conditions related to drug-induced diabetes that are not retinopathy, macular edema, or cataracts.
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 E09.39 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E09.39 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E09.39 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E09.39 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E09.39 in this effective period.
Use Additional
Official- code to identify manifestation, such as:
- diabetic glaucoma (H40-H42)
Code Also
OfficialICD-10-CM does not list Code Also instructions for E09.39 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 E09.39 an HCC code?
Yes. E09.39 maps to Diabetes with Chronic Complications under the V24 model but is not retained in V28.
- Code
- E09.39
- Description
- Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication
- 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 E09.39 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E09.39
For E09.39 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 E09.39 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E09.39 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication. Diabetes caused by medications or chemicals with eye complications other than retinopathy or cataract. E09.39 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, E09.39 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 the specific ophthalmic complication (such as diabetic macular edema, glaucoma, or corneal changes). Because E09.39 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 E09.39 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific ophthalmic complication (such as diabetic macular edema, glaucoma, or corneal changes)
- •Use more specific codes if the complication can be more precisely identified
Clinical Significance
Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication captures eye conditions related to drug-induced diabetes that are not retinopathy, macular edema, or cataracts. This includes conditions such as diabetic glaucoma, corneal epithelial changes, cranial nerve palsies affecting eye movement, or optic neuropathy. These complications may significantly impact visual function and quality of life.
Documentation Requirements
- ✓The specific ophthalmic complication must be named and described, explaining why it does not fit the retinopathy or cataract categories.
- ✓The causative drug or chemical must be identified.
- ✓Ophthalmologic examination findings, including any imaging or functional testing, should be documented to support the diagnosis.
Commonly Confused Codes
- •E09.311-E09.359 (retinopathy codes) and E09.36 (cataract) are more specific and should be used when those conditions are present.
- •E09.29 (kidney complication) or E09.49 (neurological complication) may be confused when the eye condition has overlapping neurological features.
- •H40 series (glaucoma) may need to be coded additionally.