E11.331 ICD-10-CM Code: Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
E11.331 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)
E11.331
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for E11.331. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E11.331. Check the code and parent instructions in the Code Book.
Related Codes
Includes
Official- diabetes (mellitus) due to insulin secretory defectInherited from E11
- diabetes NOSInherited from E11
- insulin resistant diabetes (mellitus)Inherited from E11
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E11
- diabetes mellitus due to underlying condition (E08.-)Inherited from E00-E89, E11
- drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E11
- gestational diabetes (O24.4-)Inherited from E00-E89, E11
- neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E11
- postpancreatectomy diabetes mellitus (E13.-)Inherited from E00-E89, E11
- postprocedural diabetes mellitus (E13.-)Inherited from E00-E89, E11
- secondary diabetes mellitus NEC (E13.-)Inherited from E00-E89, E11
- type 1 diabetes mellitus (E10.-)Inherited from E00-E89, E11
Code First
OfficialNo Code First sequencing instructions are included in this display for E11.331. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify control using:Inherited from E11
- injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E11
- insulin (Z79.4)Inherited from E11
- oral antidiabetic drugs (Z79.84)Inherited from E11
- oral hypoglycemic drugs (Z79.84)Inherited from E11
Code Also
OfficialNo Code Also instructions are included in this display for E11.331. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
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 →
- Code
- E11.331
- Description
- Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
E11.331 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. E11.331 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
E11.331 is a non-billable category for type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. Move through the official child-code path until the documented detail supports a reportable code.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E11.331 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •E11.331 is a non-billable category for type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. Move through the official child-code path until the documented detail supports a reportable code.
- •For this DOS, capture the provider's current assessment and the care action documented for type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. Keep the checklist tied to the note.
- •Do not swap E11.331 with E11.339. The FY2026 tabular describes E11.339 as type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema. Follow the documented detail.
- •The FY2026 Alphabetic Index routes Diabetes, diabetic (mellitus) (sugar) with retinopathy > nonproliferative > moderate > with macular edema to E11.331. Confirm that the indexed wording matches the provider documentation before using this route.
- •Ask Buddy to show the official notes for E11.331 or compare its code path with E11.339.