E11.311

HCC Category Mapping

What This Code Means

Type 2 diabetes that has caused damage to the blood vessels in the eye (retinopathy) with swelling in the macula, the part of the eye responsible for detailed vision.

Coding Tips

• •Macular edema indicates fluid accumulation in the macula; ensure this is specifically documented
• •The code specifies 'unspecified' retinopathy, meaning the type or stage is not further specified

Clinical Significance

Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema indicates diabetes-related retinal damage with fluid accumulation in the macula, the area of the retina responsible for central visual acuity. Macular edema is the most common cause of vision loss in diabetic patients and requires prompt treatment with anti-VEGF injections, laser photocoagulation, or corticosteroid therapy to prevent permanent vision impairment.

Documentation Requirements

• ✓Documentation must confirm diabetic retinopathy with macular edema in a Type 2 diabetic patient.
• ✓Ophthalmological examination findings including optical coherence tomography showing macular thickening, fundoscopic examination results, and visual acuity measurements should be recorded.
• ✓The laterality (right, left, bilateral) should be specified.
• ✓The retinopathy should be further classified as mild, moderate, severe nonproliferative, or proliferative when possible.

Commonly Confused Codes