E11.35 - Type 2 diabetes mellitus with proliferative diabetic retinopathy

Version 2023
ICD-10:E11.35
Short Description:Type 2 diabetes w proliferative diabetic retinopathy
Long Description:Type 2 diabetes mellitus with proliferative diabetic retinopathy
Status: Not Valid for Submission
Version:ICD-10-CM 2023
Code Classification:
  • Endocrine, nutritional and metabolic diseases (E00–E90)
    • Diabetes mellitus (E08-E13)
      • Type 2 diabetes mellitus (E11)

E11.35 is a non-specific and non-billable ICD-10 code code, consider using a code with a higher level of specificity for a diagnosis of type 2 diabetes mellitus with proliferative diabetic retinopathy. The code is not specific and is NOT valid for the year 2023 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.

Coding Guidelines

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 - E13 as needed to identify all of the associated conditions that the patient has.

If the type of diabetes mellitus is not documented in the medical record the default is E11.-, Type 2 diabetes mellitus.

Specific Coding for Type 2 diabetes w proliferative diabetic retinopathy

Non-specific codes like E11.35 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for type 2 diabetes w proliferative diabetic retinopathy:

  • NON-BILLABLE CODE - E11.351 for Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
  • BILLABLE CODE - Use E11.3511 for right eye
  • BILLABLE CODE - Use E11.3512 for left eye
  • BILLABLE CODE - Use E11.3513 for bilateral
  • BILLABLE CODE - Use E11.3519 for unspecified eye
  • NON-BILLABLE CODE - E11.352 for Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula
  • BILLABLE CODE - Use E11.3521 for right eye
  • BILLABLE CODE - Use E11.3522 for left eye
  • BILLABLE CODE - Use E11.3523 for bilateral
  • BILLABLE CODE - Use E11.3529 for unspecified eye
  • NON-BILLABLE CODE - E11.353 for Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula
  • BILLABLE CODE - Use E11.3531 for right eye
  • BILLABLE CODE - Use E11.3532 for left eye
  • BILLABLE CODE - Use E11.3533 for bilateral
  • BILLABLE CODE - Use E11.3539 for unspecified eye
  • NON-BILLABLE CODE - E11.354 for Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment
  • BILLABLE CODE - Use E11.3541 for right eye
  • BILLABLE CODE - Use E11.3542 for left eye
  • BILLABLE CODE - Use E11.3543 for bilateral
  • BILLABLE CODE - Use E11.3549 for unspecified eye
  • NON-BILLABLE CODE - E11.355 for Type 2 diabetes mellitus with stable proliferative diabetic retinopathy
  • BILLABLE CODE - Use E11.3551 for right eye
  • BILLABLE CODE - Use E11.3552 for left eye
  • BILLABLE CODE - Use E11.3553 for bilateral
  • BILLABLE CODE - Use E11.3559 for unspecified eye
  • NON-BILLABLE CODE - E11.359 for Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
  • BILLABLE CODE - Use E11.3591 for right eye
  • BILLABLE CODE - Use E11.3592 for left eye
  • BILLABLE CODE - Use E11.3593 for bilateral
  • BILLABLE CODE - Use E11.3599 for unspecified eye

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to this diagnosis code:


7th Character Note

7th Character Note
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.

7th Character

7th Character
Indicates that a seventh character is to be assigned to codes in a subcategory.

Patient Education


Diabetes Type 2

What is type 2 diabetes?

Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well. The glucose then stays in your blood and not enough goes into your cells.

Over time, having too much glucose in your blood can cause health problems. But you can take steps to manage your diabetes and try to prevent these health problems.

What causes type 2 diabetes?

Type 2 diabetes may be caused by a combination of factors:

Type 2 diabetes usually starts with insulin resistance. This is a condition in which your cells don't respond normally to insulin. As a result, your body needs more insulin to help the glucose enter your cells. At first, your body makes more insulin to try to get cells to respond. But over time, your body can't make enough insulin, and your blood glucose levels rise.

Who is at risk for type 2 diabetes?

You are at higher risk of developing type 2 diabetes if you:

What are the symptoms of type 2 diabetes?

Many people with type 2 diabetes have no symptoms at all. If you do have them, the symptoms develop slowly over several years. They might be so mild that you do not notice them. The symptoms can include:

How is type 2 diabetes diagnosed?

Your health care provider will use blood tests to diagnose type 2 diabetes. The blood tests include:

What are the treatments for type 2 diabetes?

Treatment for type 2 diabetes involves managing your blood sugar levels. Many people are able to do this by living a healthy lifestyle. Some people may also need to take medicine.:

Can type 2 diabetes be prevented?

You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. If you have a condition which raises your risk for type 2 diabetes, managing that condition may lower your risk of getting type 2 diabetes.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


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Diabetic Eye Problems

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood sugar levels.

What eye problems can diabetes cause?

Over time, high blood sugar may damage the blood vessels and lenses in your eyes. This can lead to serious diabetic eye problems which can harm your vision and sometimes cause blindness. Some common diabetes eye problems include:

Who is more likely to develop diabetic eye problems?

Anyone with diabetes can develop diabetic eye disease. But your risk of developing it is higher if you:

What are the symptoms of diabetic eye problems?

In the early stages, diabetic eye problems usually don't have any symptoms. That's why regular dilated eye exams are so important, even if you think your eyes are healthy.

You should also watch for sudden changes in your vision that could mean an emergency. Call your doctor right away if you notice any of these symptoms:

Talk with your doctor if you have these symptoms, even if they come and go:

How are diabetic eye problems diagnosed?

Eye doctors do dilated eye exams to diagnose eye problems. A dilated eye exam uses eye drops to open your pupils wide so your doctor can look for signs of eye problems and treat them before they harm your vision. Your doctor will also test your vision and measure the pressure in your eyes.

What are the treatments for diabetic eye problems?

Treatment for diabetic eye problems depends on the problem and how serious it is. Some of the treatments include:

But these treatments aren't cures. Eye problems can come back. That's why your best defense against serious vision loss is to take control of your diabetes and get regular eye exams. It's also important to keep your blood pressure and cholesterol in a healthy range.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


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Type 2 diabetes

Type 2 diabetes is a disorder characterized by abnormally high blood sugar levels. In this form of diabetes, the body stops using and making insulin properly. Insulin is a hormone produced in the pancreas that helps regulate blood sugar levels. Specifically, insulin controls how much glucose (a type of sugar) is passed from the blood into cells, where it is used as an energy source. When blood sugar levels are high (such as after a meal), the pancreas releases insulin to move the excess glucose into cells, which reduces the amount of glucose in the blood.

Most people who develop type 2 diabetes first have insulin resistance, a condition in which the body's cells use insulin less efficiently than normal. As insulin resistance develops, more and more insulin is needed to keep blood sugar levels in the normal range. To keep up with the increasing need, insulin-producing cells in the pancreas (called beta cells) make larger amounts of insulin. Over time, the beta cells become less able to respond to blood sugar changes, leading to an insulin shortage that prevents the body from reducing blood sugar levels effectively. Most people have some insulin resistance as they age, but inadequate exercise and excessive weight gain make it worse, greatly increasing the likelihood of developing type 2 diabetes.

Type 2 diabetes can occur at any age, but it most commonly begins in middle age or later. Signs and symptoms develop slowly over years. They include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet (diabetic neuropathy), sores that do not heal well, and weight loss. If blood sugar levels are not controlled through medication or diet, type 2 diabetes can cause long-lasting (chronic) health problems including heart disease and stroke; nerve damage; and damage to the kidneys, eyes, and other parts of the body.


[Learn More in MedlinePlus]

Diabetic Eye Disease

Learn about diabetes and eye disease; symptoms, warning signs, and treatments; and how you can prevent eye disease—or keep it from getting worse.
[Learn More in MedlinePlus]

Code History