E11.3411 ICD-10-CM Code: Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
E11.3411 maps to CMS-HCC V28 HCCs 37 and 298. Source-labeled RAF references are available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.3411
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
CMS-HCC V28
MappedHCC 37
Code-level coefficient reference
+ HCC 298
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 020
Code-level coefficient reference
ESRD/PACE
MappedHCC 18
Code-level coefficient reference
RXHCC
MappedHCC 30
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.3411 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.3411 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.3411 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.3411 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.3411 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.3411 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.3411 in this effective period.
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 →
Is E11.3411 an HCC code?
Yes. E11.3411 (Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye) maps to HCC 37, Diabetes with Chronic Complications and HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage under the CMS-HCC V28 risk adjustment model, with source-labeled community non-dual aged reference coefficients HCC 37 0.166 and HCC 298 0.336. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: E11.3411 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications and HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.3411
- Description
- Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications; HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
- RAF reference coefficient
- HCC 37: 0.166; HCC 298: 0.336
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work E11.3411 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for E11.3411
For E11.3411 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 E11.3411 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E11.3411 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye. E11.3411 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, E11.3411 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E11.3411; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Coders should report E11.3411 only when the provider documentation supports the specific condition described, since more specific codes within the same hierarchy can capture additional clinical detail. Because E11.3411 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for E11.3411 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.