E10.36
BillableType 1 diabetes mellitus with diabetic cataract
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.36 an HCC code?
Yes. E10.36 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for E10.36
For E10.36 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 E10.36 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.36 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with diabetic cataract. Type 1 diabetes causing clouding of the eye lens, which develops as a direct result of prolonged high blood sugar. E10.36 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 CMS-HCC V28 risk adjustment model, E10.36 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E10.36 mapped to the same category but with a base RAF weight of 0.302 — V28 recalibrated weights across the entire model. 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.
Diabetic cataracts typically develop earlier and progress faster than age-related cataracts. Because E10.36 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 E10.36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Diabetic cataracts typically develop earlier and progress faster than age-related cataracts
- •Document whether cataract is unilateral or bilateral if applicable
Clinical Significance
Type 1 diabetes mellitus with diabetic cataract indicates lens opacification directly caused by the metabolic effects of Type 1 diabetes. Diabetic cataracts develop through the polyol pathway where excess glucose is converted to sorbitol, causing osmotic swelling and disruption of lens fibers. In Type 1 diabetes, cataracts may develop at significantly younger ages than typical age-related cataracts and can progress more rapidly, particularly during periods of poor glycemic control.
Documentation Requirements
- ✓Documentation must confirm Type 1 diabetes and establish that the cataract is attributable to diabetes rather than age or other causes.
- ✓Ophthalmologic examination findings including lens opacity description, visual acuity impact, and surgical candidacy assessment should be documented.
- ✓The characteristic snowflake or subcapsular pattern typical of diabetic cataracts should be noted when present.
Commonly Confused Codes
- •H25 (age-related cataract) should be used for cataracts not attributable to diabetes.
- •E10.39 (other ophthalmic complication) is for eye conditions other than cataracts and retinopathy.
- •E10.311/E10.319 (retinopathy codes) may coexist with cataracts and should be coded separately.
- •H26.9 (unspecified cataract) lacks the diabetes-specific context.