ICD-10 E11.36
Billable / Specific HCC v28: 18Type 2 diabetes mellitus with diabetic cataract
About ICD-10-CM E11.36
ICD-10-CM code E11.36 represents Type 2 diabetes mellitus with diabetic cataract. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.36 became effective on October 1, 2025.
Coding Tips for E11.36
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E11.36 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 E11.36
Local Coverage Determinations (LCDs) from CMS MACs that list E11.36 as a covered diagnosis.
Showing top 10 of 275 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E11.36.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E11.36
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 66987 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66840 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66852 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66850 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66940 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66983 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66988 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66982 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 66920 CMS LCD: Billing and Coding: Cataract Extraction (including Complex Cataract Surgery) CMS LCD
- 76519 CMS LCD: Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation CMS LCD
Convert E11.36 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 |
|---|---|---|
| E11.36 | 25050 | 10111 |
| E11.36 | 36641 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E11.36
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.36, Billing FAQ
Is ICD-10 code E11.36 billable? +
Yes, E11.36 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E11.36 affect Medicare Advantage HCC risk adjustment? +
Yes. E11.36 maps to CMS-HCC v28 category 18. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E11.36? +
Procedures frequently paired with E11.36 include: 66987, 66840, 66852, 66850, 66940.
What ICD-9 codes does E11.36 map to? +
Per CMS GEMs, E11.36 maps to ICD-9 codes: 25050, 36641. 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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