E11.3592 ICD-10-CM Code: Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.3592
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 30
RAF 0.0
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.3592 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.3592 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.3592 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.3592 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.3592 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.3592 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.3592 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is E11.3592 an HCC code?
No. E11.3592 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 E11.3592
For E11.3592to 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 E11.3592 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
E11.3592 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye. E11.3592 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
E11.3592 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Type 2 diabetes with proliferative diabetic retinopathy without macular edema, left eye. PDR, no macular edema, left eye, all three required.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E11.3592 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.