Alphabetic Index FY2027

E11.3412

Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye

FY2027Chapter 4: Endocrine, nutritional and metabolic diseases/E08–E13 Diabetes mellitus

BillableComplete code, valid to report
Care settingsHome Health Primary · MMTA - Endocrine

E11.3412 (also written E113412) is a billable ICD-10-CM diagnosis code for type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye. It is part of the FY2027 code set, effective October 1, 2026. It is one of the 87 codes in category E11 (Type 2 diabetes mellitus). The Alphabetic Index lists it under 2 entries. Its 7th character, 2, means left eye. Its coding notes include a Use additional code instruction and 9 Excludes1 entries.

7th character

Category E11.34 requires a 7th character.

Assembled code E11.3412 Open code

Guidelines tips

From the FY2027 Official Guidelines. ICD10Ref adds no rules of its own.

If the type of diabetes is not documented, the default is E11.-. Use of insulin, oral hypoglycemics or injectable non-insulin drugs adds a Z79 code, except when insulin is given temporarily.

Guidelines I.C.4.a.2; I.C.4.a.3Diabetes mellitus: type not documented and insulin useRead the official text

Diabetes codes combine the type, the body system and the complication, and as many codes as needed are assigned to describe all complications.

Guidelines I.C.4.aDiabetes: combination codesRead the official text

Use additional code

Add the listed code as a secondary code, if known.

Inherited from E11 Type 2 diabetes mellitus
  • 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)

Excludes1

Not coded here. The listed conditions generally should not be reported together.

Inherited from E11 Type 2 diabetes mellitus
  • diabetes mellitus due to underlying condition (E08.-)
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • neonatal diabetes mellitus (P70.2)
  • postpancreatectomy diabetes mellitus (E13.-)
  • postprocedural diabetes mellitus (E13.-)
  • secondary diabetes mellitus NEC (E13.-)
  • type 1 diabetes mellitus (E10.-)
Also from chapter/block level (1 note)
Inherited from Chapter 4 Endocrine, nutritional and metabolic diseases
  • transitory endocrine and metabolic disorders specific to newborn (P70-P74)

Care settings

How CMS programs treat this code. These are CMS claim edits and list entries, not coverage or eligibility rules.

Home Health Primary

Accepted as the primary (principal) diagnosis on a home health claim. The Home Health Grouper assigns it to the MMTA - Endocrine clinical group.

Source: CMS Home Health Grouper Software v07.2.26, effective October 1, 2026

Includes

Further defines or gives examples of the content of the category.

Inherited from E11 Type 2 diabetes mellitus
  • diabetes (mellitus) due to insulin secretory defect
  • diabetes NOS
  • insulin resistant diabetes (mellitus)

Notes

Also from chapter/block level (1 note)
Inherited from Chapter 4 Endocrine, nutritional and metabolic diseases
  • All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.

Alphabetic Index terms

Terms the official Alphabetic Index lists for E11.341. This code adds the 7th character. 2 entries