E10.39
BillableType 1 diabetes mellitus with other diabetic ophthalmic complication
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.39 an HCC code?
Yes. E10.39 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 E10.39
For E10.39 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 E10.39 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.39 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with other diabetic ophthalmic complication. Type 1 diabetes with eye complications other than retinopathy or cataracts, such as glaucoma or corneal changes from diabetes. E10.39 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 CMS-HCC V28 risk adjustment model, E10.39 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, E10.39 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.
Use only when the ophthalmic complication is not retinopathy, macular edema, or cataract. Because E10.39 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 E10.39 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when the ophthalmic complication is not retinopathy, macular edema, or cataract
- •Ensure documentation specifies the particular eye condition related to diabetes
Clinical Significance
Type 1 diabetes mellitus with other diabetic ophthalmic complication captures eye conditions from Type 1 diabetes that are not classified as retinopathy, macular edema, or cataracts. This includes neovascular glaucoma, diabetic papillopathy, diabetic corneal neuropathy with recurrent erosions, or extraocular muscle palsies from diabetic cranial neuropathy. These conditions may cause significant visual impairment and require specialized ophthalmologic management.
Documentation Requirements
- ✓The specific ophthalmic complication must be identified and described, demonstrating why standard retinopathy and cataract codes do not apply.
- ✓Type 1 diabetes must be confirmed.
- ✓Ophthalmologic examination findings, diagnostic testing results, and treatment plans should be documented.
- ✓The causal relationship between diabetes and the eye condition must be established.