E13.311

HCC Category Mapping

What This Code Means

A secondary form of diabetes that has damaged the blood vessels in the eye, causing swelling in the macula (central vision area).

Coding Tips

• •Macular edema is a serious complication affecting vision; verify ophthalmology documentation confirms this finding
• •The fifth character '1' indicates macular edema is present; use E13.319 if macular edema is absent

Clinical Significance

E13.311 identifies unspecified diabetic retinopathy with macular edema in other specified diabetes. Macular edema represents fluid accumulation in the macula causing central vision impairment and is one of the leading causes of vision loss in diabetic patients. The 'unspecified' designation indicates the retinopathy stage (mild, moderate, severe, or proliferative) has not been documented.

Documentation Requirements

• ✓Documentation must confirm secondary diabetes, the presence of retinopathy, and macular edema as verified by ophthalmologic examination or retinal imaging.
• ✓The provider should be queried to specify the retinopathy stage (nonproliferative mild/moderate/severe or proliferative) to allow for more specific code assignment.

Commonly Confused Codes