E13.36
BillableOther specified diabetes mellitus with diabetic cataract
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.36 an HCC code?
Yes. E13.36 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 E13.36
For E13.36 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 E13.36 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.36 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with diabetic cataract. A type of diabetes (not type 1 or type 2) that causes clouding of the eye lens, leading to vision problems or blindness. E13.36 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, E13.36 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, E13.36 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.
Verify the diabetes type is documented as 'other specified' rather than type 1 or type 2. Because E13.36 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 E13.36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the diabetes type is documented as 'other specified' rather than type 1 or type 2
- •Ensure the cataract is specifically documented as diabetic-related, not from other causes
Clinical Significance
E13.36 identifies diabetic cataract in patients with other specified (secondary) diabetes mellitus. Diabetic cataracts develop due to chronic hyperglycemia-induced osmotic changes in the lens, leading to swelling, opacity, and progressive vision impairment. These cataracts can occur at younger ages and progress more rapidly than age-related cataracts.
Documentation Requirements
- ✓The provider must document the secondary diabetes type with its underlying cause and confirm that the cataract is directly attributed to the diabetes.
- ✓Ophthalmology examination findings including lens opacity characteristics should be documented.
- ✓Age-related cataracts in a diabetic patient should not automatically be coded as diabetic cataracts.