ICD-10 E09.311
Billable / Specific HCC v28: 18Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema
About ICD-10-CM E09.311
ICD-10-CM code E09.311 represents Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E09). The 2026 edition of ICD-10-CM E09.311 became effective on October 1, 2025.
Coding Tips for E09.311
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E09.311 is a CMS-HCC v28 risk-adjustment code (category 18). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for E09.311
Local Coverage Determinations (LCDs) from CMS MACs that list E09.311 as a covered diagnosis.
Showing top 10 of 148 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E09.311.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E09.311
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 92274 CMS LCD: Billing and Coding: Electroretinography (ERG) CMS LCD
- 0509T CMS LCD: Billing and Coding: Electroretinography (ERG) CMS LCD
- 92273 CMS LCD: Billing and Coding: Electroretinography (ERG) CMS LCD
- J7999 CMS LCD: Billing and Coding: Intraocular Bevacizumab CMS LCD
- C9257 CMS LCD: Billing and Coding: Intraocular Bevacizumab CMS LCD
- 92134 CMS LCD: Billing and Coding: Intraocular Bevacizumab CMS LCD
- 0464T CMS LCD: Billing and Coding: Visual Electrophysiology Testing CMS LCD
- 0333T CMS LCD: Billing and Coding: Visual Electrophysiology Testing CMS LCD
- J2777 CMS LCD: Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU�aflibercept-ayyh, AHZANTIVE�aflibercept-abzv. ENZEEVU�aflibercept-mrbb, OPUVIZ�aflibercept-yszy and YESAFILI� aflibercept-jbvf CMS LCD
- J2778 CMS LCD: Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU�aflibercept-ayyh, AHZANTIVE�aflibercept-abzv. ENZEEVU�aflibercept-mrbb, OPUVIZ�aflibercept-yszy and YESAFILI� aflibercept-jbvf CMS LCD
Convert E09.311 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E09.311 | 24950 | 10000 |
| E09.311 | 24950 | 10111 |
| E09.311 | 36201 | 10112 |
| E09.311 | 36207 | 10113 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E09.311
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E09.311, Billing FAQ
Is ICD-10 code E09.311 billable? +
Yes, E09.311 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E09.311 affect Medicare Advantage HCC risk adjustment? +
Yes. E09.311 maps to CMS-HCC v28 category 18. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E09.311? +
Procedures frequently paired with E09.311 include: 92274, 0509T, 92273, J7999, C9257.
What ICD-9 codes does E09.311 map to? +
Per CMS GEMs, E09.311 maps to ICD-9 codes: 24950, 24950, 36201, 36207. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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