E13.3513 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral

Billable ICD-10-CM code, FY2026.

Built from E13.351 with 7th character 3 (bilateral).

Applies from E13 Other specified diabetes mellitus

Includes

• diabetes mellitus due to genetic defects of beta-cell function
• diabetes mellitus due to genetic defects in insulin action
• postpancreatectomy diabetes mellitus
• postprocedural diabetes mellitus
• secondary diabetes mellitus NEC

Excludes1 (never code together)

• diabetes (mellitus) due to autoimmune process (E10.-)
• diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
• diabetes mellitus due to underlying condition (E08.-)
• drug or chemical induced diabetes mellitus (E09.-)
• gestational diabetes (O24.4-)
• neonatal diabetes mellitus (P70.2)
• type 1 diabetes mellitus (E10.-)

Use additional code

• code to identify control using:
• injectable non-insulin antidiabetic drugs (Z79.85)
• insulin (Z79.4)
• oral antidiabetic drugs (Z79.84)
• oral hypoglycemic drugs (Z79.84)

Applies from E13.35 Other specified diabetes mellitus with proliferative diabetic retinopathy

7th character note

• One of the following 7th characters is to be assigned to codes in subcategory E13.35 to designate laterality of the disease:

7th character required

• 1 — right eye
• 2 — left eye
• 3 — bilateral
• 9 — unspecified eye

Risk adjustment (HCC)

• CMS-HCC V28: HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage
• CMS-HCC V22: HCC 122 — Proliferative Diabetic Retinopathy and Vitreous Hemorrhage
• ESRD V24: HCC 122

Code annotations containing back-references to E13.3513

Back-references to E13.3

• Type 1 Excludes: H36 Retinal disorders in diseases classified elsewhere ("diabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-)")

Back-references to E13

• Code First: D84.81 Immunodeficiency due to conditions classified elsewhere ("diabetes mellitus (E08-E13)")
• Type 1 Excludes: E08 Diabetes mellitus due to underlying condition ("postpancreatectomy diabetes mellitus (E13.-)")
• Type 1 Excludes: E08 Diabetes mellitus due to underlying condition ("postprocedural diabetes mellitus (E13.-)")
• Type 1 Excludes: E08 Diabetes mellitus due to underlying condition ("secondary diabetes mellitus NEC (E13.-)")
• Type 1 Excludes: E09 Drug or chemical induced diabetes mellitus ("postpancreatectomy diabetes mellitus (E13.-)")
• Type 1 Excludes: E09 Drug or chemical induced diabetes mellitus ("postprocedural diabetes mellitus (E13.-)")
• Type 1 Excludes: E09 Drug or chemical induced diabetes mellitus ("secondary diabetes mellitus NEC (E13.-)")
• Type 1 Excludes: E10 Type 1 diabetes mellitus ("postpancreatectomy diabetes mellitus (E13.-)")
• Type 1 Excludes: E10 Type 1 diabetes mellitus ("postprocedural diabetes mellitus (E13.-)")
• Type 1 Excludes: E10 Type 1 diabetes mellitus ("secondary diabetes mellitus NEC (E13.-)")
• Type 1 Excludes: E11 Type 2 diabetes mellitus ("postpancreatectomy diabetes mellitus (E13.-)")
• Type 1 Excludes: E11 Type 2 diabetes mellitus ("postprocedural diabetes mellitus (E13.-)")
• Type 1 Excludes: E11 Type 2 diabetes mellitus ("secondary diabetes mellitus NEC (E13.-)")
• Type 1 Excludes: E74 Other disorders of carbohydrate metabolism ("diabetes mellitus (E08-E13)")
• Type 2 Excludes: E87.0 Hyperosmolality and hypernatremia ("diabetes with hyperosmolarity (E08, E09, E11, E13 with final characters .00 or .01)")
• Type 1 Excludes: E87.2 Acidosis ("diabetic acidosis - see categories E08-E10, E11, E13 with ketoacidosis")
• Code First: E89.1 Postprocedural hypoinsulinemia (", if applicable, diabetes mellitus (postpancreatectomy) (postprocedural) (E13.-)")
• Type 1 Excludes: G54.5 Neuralgic amyotrophy ("neuralgic amyotrophy in diabetes mellitus (E08-E13 with .44)")
• Type 1 Excludes: G59 Mononeuropathy in diseases classified elsewhere ("diabetic mononeuropathy (E08-E13 with .41)")
• Type 1 Excludes: G63 Polyneuropathy in diseases classified elsewhere ("diabetes mellitus (E08-E13 with .42)")
• Type 1 Excludes: G99.0 Autonomic neuropathy in diseases classified elsewhere ("diabetic autonomic neuropathy (E08-E13 with .43)")
• Type 1 Excludes: H20.0 Acute and subacute iridocyclitis ("iridocyclitis, iritis, uveitis (due to) (in) diabetes mellitus (E08-E13 with .39)")
• Type 1 Excludes: I73.8 Other specified peripheral vascular diseases ("diabetic (peripheral) angiopathy (E08-E13 with .51-.52)")
• Type 1 Excludes: I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere ("diabetic (peripheral) angiopathy (E08-E13 with .51-.52)")
• Type 2 Excludes: I96 Gangrene, not elsewhere classified ("gangrene in diabetes mellitus (E08-E13 with .52)")
• Type 1 Excludes: L92.1 Necrobiosis lipoidica, not elsewhere classified ("necrobiosis lipoidica associated with diabetes mellitus (E08-E13 with .620)")
• Type 1 Excludes: L99 Other disorders of skin and subcutaneous tissue in diseases classified elsewhere ("skin disorders in diabetes (E08-E13 with .62-)")
• Type 1 Excludes: M14 Arthropathies in other diseases classified elsewhere ("diabetes mellitus (E08-E13 with .61-)")
• Type 1 Excludes: M14.6 Charcôt's joint ("Charcôt's joint in diabetes mellitus (E08-E13 with .610)")
• Type 1 Excludes: M90 Osteopathies in diseases classified elsewhere ("diabetes mellitus (E08-E13 with .69-)")
• Type 1 Excludes: N08 Glomerular disorders in diseases classified elsewhere ("diabetes (E08-E13 with .21)")
• Type 1 Excludes: N16 Renal tubulo-interstitial disorders in diseases classified elsewhere ("renal tubular degeneration in diabetes (E08-E13 with .29)")
• Type 1 Excludes: N76.82 Fournier disease of vagina and vulva ("gangrene in diabetes mellitus (E08-E13 with .52)")
• Code Also: N76.82 Fournier disease of vagina and vulva (", if applicable, diabetes mellitus (E08-E13 with .9)")
• Use Additional: O24.8 Other pre-existing diabetes mellitus in pregnancy, childbirth, and the puerperium ("from categories E08, E09 and E13 to further identify any manifestation")
• Use Additional: O24.9 Unspecified diabetes mellitus in pregnancy, childbirth and the puerperium ("from categories E08, E09 and E13 to further identify any manifestation")
• Type 1 Excludes: R40 Somnolence, stupor and coma ("somnolence, stupor and coma in diabetes (E08-E13)")
• Type 1 Excludes: R73 Elevated blood glucose level ("diabetes mellitus (E08-E13)")
• Type 1 Excludes: R73.0 Abnormal glucose ("diabetes mellitus (E08-E13)")
• Use Additional: Z90.41 Acquired absence of pancreas ("diabetes mellitus, postpancreatectomy (E13.-)")

Diagnosis Index entries for E13.3513

• Diabetes, diabetic (mellitus) (sugar) › specified type NEC › with › retinopathy › proliferative › with › macular edema

Nearby codes

• E13.3499 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye
• E13.35 Other specified diabetes mellitus with proliferative diabetic retinopathy
• E13.351 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
• E13.3511 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
• E13.3512 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye
• E13.3513 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral (this code)
• E13.3519 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye
• E13.352 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula
• E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye
• E13.3522 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye
• E13.3523 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral