E11.39
BillableType 2 diabetes mellitus with other diabetic ophthalmic complication
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.39 an HCC code?
Yes. E11.39 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24).
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 E11.39
For E11.39 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 E11.39 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.39 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with other diabetic ophthalmic complication. Type 2 diabetes with eye complications other than retinopathy or cataracts, such as diabetic macular edema, glaucoma, or other vision problems caused by diabetes. E11.39 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, E11.39 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E11.39 mapped to the same category but with a base RAF weight of 0.302 — V28 recalibrated weights across the entire model. 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.
Use this code only when the eye complication is not retinopathy or cataract. Because E11.39 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for E11.39 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the eye complication is not retinopathy or cataract
- •Document the specific ophthalmic complication in the medical record for clarity and future reference
Clinical Significance
Type 2 diabetes mellitus with other diabetic ophthalmic complication captures eye conditions attributable to diabetes beyond retinopathy and cataract, such as diabetic papillopathy, cranial nerve palsies affecting extraocular muscles, neovascular glaucoma, or diabetic maculopathy without retinopathy classification. These less common ophthalmic complications still represent significant visual morbidity requiring specialized care.
Documentation Requirements
- ✓The medical record must identify the specific ophthalmic complication and its relationship to Type 2 diabetes.
- ✓Comprehensive eye examination findings, specialized testing (visual fields, tonometry, OCT), and treatment plans should be documented.
- ✓The provider must confirm the condition is not retinopathy or cataract, which have their own specific codes.