ICD-10 E11.319
Billable / Specific HCC v28: 18Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
About ICD-10-CM E11.319
ICD-10-CM code E11.319 represents Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.319 became effective on October 1, 2025.
Coding Tips for E11.319
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E11.319 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 E11.319
Local Coverage Determinations (LCDs) from CMS MACs that list E11.319 as a covered diagnosis.
Showing top 10 of 286 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E11.319.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E11.319
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 92014 Comprehensive eye exam established — glaucoma, glaucoma suspect, diabetic retinopathy, macular degeneration, routine eye exam, myopia, presbyopia, visual disturbance Ophthalmology
- 43645 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43888 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43845 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43848 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43772 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43659 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43644 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43774 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
- 43775 CMS LCD: Billing and Coding: Bariatric Surgical Management of Morbid Obesity CMS LCD
Convert E11.319 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 |
|---|---|---|
| E11.319 | 25050 | 10111 |
| E11.319 | 36201 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E11.319
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.319, Billing FAQ
Is ICD-10 code E11.319 billable? +
Yes, E11.319 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E11.319 affect Medicare Advantage HCC risk adjustment? +
Yes. E11.319 maps to CMS-HCC v28 category 18. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E11.319? +
Procedures frequently paired with E11.319 include: 92014, 43645, 43888, 43845, 43848.
What ICD-9 codes does E11.319 map to? +
Per CMS GEMs, E11.319 maps to ICD-9 codes: 25050, 36201. 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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