E11.39 ICD-10-CM Code: Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.39 maps to CMS-HCC V28 37. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.39
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 37
Code-level coefficient reference
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
OfficialNo inclusion terms are included in this display for E11.39. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E11.39. 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 E11.39. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify manifestation, such as:
- diabetic glaucoma (H40-H42)
- 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 E11.39. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E11.39 an HCC code?
Yes. E11.39 (Type 2 diabetes mellitus with other diabetic ophthalmic complication) maps to HCC 37, Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.166. 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: E11.39 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.39
- Description
- Type 2 diabetes mellitus with other diabetic ophthalmic complication
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications
- RAF reference coefficient
- 0.166
- 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 E11.39 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E11.39
For E11.39, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
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 source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E11.39; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Use this code only when the eye complication is not retinopathy or cataract. For E11.39, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 E11.39 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.
Commonly Confused Codes
- •E11.311/E11.319 (diabetic retinopathy with/without macular edema) are specific to retinal vascular disease.
- •E11.36 (diabetic cataract) covers lens opacity.
- •H40 series (glaucoma) codes may be used additionally when neovascular glaucoma is documented.
- •E11.69 (other specified complication) is too broad when the complication is specifically ophthalmic.