E11.319
BillableType 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
HCC Category Mapping
V28HCC 37 — Diabetes with Chronic Complications
0.245V24HCC 18 — Diabetes with Chronic Complications
0.302ESRDHCC 18 — Diabetes with Chronic Complications
0.000RxHCCHCC 30 — Diabetes with Complications
0.000What This Code Means
Type 2 diabetes that has damaged the blood vessels in the eye (retinopathy) without swelling in the macula.
Coding Tips
- •Confirm that macular edema is NOT present before using this code; if present, use E11.311
- •This code represents retinopathy without the more serious complication of macular involvement
Clinical Significance
Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema indicates diabetes-related retinal vascular damage that has not yet affected the macula. While less immediately sight-threatening than retinopathy with macular edema, this condition still requires regular ophthalmological monitoring to detect progression. Early-stage retinopathy may be managed with glycemic optimization and blood pressure control alone.
Documentation Requirements
- ✓Documentation must confirm diabetic retinopathy without macular edema in a Type 2 diabetic patient.
- ✓Fundoscopic examination findings, retinal imaging results, and visual acuity should be recorded.
- ✓The provider should specify the retinopathy stage (mild, moderate, severe nonproliferative, or proliferative) when possible to enable more specific coding.
- ✓Laterality should be documented.
Commonly Confused Codes
E11.311 (with macular edema) is used when macular involvement is documented and maps differently for HCC purposes.E11.3211-E11.3599 (specific retinopathy stages) provide greater specificity and should be used when the stage is documented.E11.39 (other ophthalmic complication) covers eye conditions other than retinopathy or cataract.
Code Hierarchy
└E11Type 2 diabetes mellitus└E11.3Type 2 diabetes mellitus with ophthalmic complications└E11.31Type 2 diabetes mellitus with unspecified diabetic retinopathy└E11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
└E11.319Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema