2026 ICD-10-CM Diagnosis Code E11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema

ICD-10-CM Codes›E00–E89›E08-E13›E11

ICD-10-CM E11.311
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

E11.311 is a billable ICD-10-CM diagnosis code for type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 124 through 125. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Diabetes mellitus with complication; Diabetes mellitus, Type 2; and Retinal and vitreous conditions.

This medical diagnosis code is frequently used in Family Practice medical specialties to designate conditions such diabetes mellitus with complications type 2.

Code Identity

ICD-10-CM Code
E11.311
Billable Status
Yes — Valid for Submission
Code Describes
Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
Short Description
Type 2 diabetes w unsp diabetic retinopathy w macular edema
Parent Code
E11.31
Type 2 diabetes mellitus with unspecified diabetic retinopathy

Code Classification

ChapterE00–E89Endocrine, nutritional and metabolic diseases
SectionE08-E13Diabetes mellitus
CategoryE11Type 2 diabetes mellitus
This CodeE11.311Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when E11.311 is part of the patient record.

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

High Priority: YES

Measure Type: Intermediateoutcome

Submission Methods: Claims, Electronic Health Record, Cms Web Interface, Registry

Description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

View Measure

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Advanced maculopathy due to diabetes mellitus
  • Centrally involved macular edema due to diabetes mellitus
  • Clinically significant macular edema
  • Clinically significant macular edema due to diabetes mellitus
  • Clinically significant macular edema of left eye due to diabetes mellitus
  • Clinically significant macular edema of right eye due to diabetes mellitus
  • Cystoid macular edema due to diabetes mellitus
  • Diabetic maculopathy of bilateral eyes present
  • Diffuse exudative maculopathy due to diabetes mellitus
  • Disorder of left macula due to diabetes mellitus
  • Disorder of macula due to diabetes mellitus
  • Disorder of macula of bilateral eyes due to diabetes mellitus
  • Disorder of right macula due to diabetes mellitus
  • Exudative age-related macular degeneration
  • Focal exudative maculopathy due to diabetes mellitus
  • Macular edema and retinopathy due to type 2 diabetes mellitus
  • Macular edema due to diabetes mellitus
  • Macular edema due to type 2 diabetes mellitus
  • Macular edema not clinically significant due to diabetes mellitus
  • Macular edema of left eye due to diabetes mellitus
  • Macular edema of right eye due to diabetes mellitus
  • Mild diabetic macular edema
  • Moderate diabetic macular edema
  • Non centrally involved macular edema due to diabetes mellitus
  • Persistent macular edema due to diabetes mellitus
  • Retinal edema due to diabetes mellitus
  • Retinal edema due to type 2 diabetes mellitus
  • Severe diabetic macular edema

Coding GuidelinesGuidance

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.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Diabetes, diabetic(mellitus) (sugar)
      • with
        • retinopathy
          • with macular edema
    • Diabetes, diabetic(mellitus) (sugar)
      • type 2
        • with
          • retinopathy
            • with macular edema

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR END003
Diabetes mellitus with complication
Default principal diagnosis: inpatient Yes · outpatient Yes
CCSR END005
Diabetes mellitus, Type 2
Default principal diagnosis: inpatient No · outpatient No
CCSR EYE005
Retinal and vitreous conditions
Default principal diagnosis: inpatient No · outpatient No

Patient EducationClinical

Diabetes Type 2

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 full article covers:

  • What is type 2 diabetes?
  • What causes type 2 diabetes?
  • Who is at risk for type 2 diabetes?
  • What are the symptoms of type 2 diabetes?
  • How is type 2 diabetes diagnosed?
  • What are the treatments for type 2 diabetes?
  • Can type 2 diabetes be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert E11.311 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
250.50 DMII ophth nt st uncntrl
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
362.01 Diabetic retinopathy NOS
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
362.07 Diabetic macular edema
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About E11.311Overview

Is E11.311 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does E11.311 group to?

When type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema is the principal diagnosis on an inpatient stay, it groups to MS-DRG 124, 125, with relative weights from 0.7678 to 1.3231 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of E11.311?

Under the General Equivalence Mappings, type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema converts to ICD-9-CM 250.50 (DMII ophth nt st uncntrl), 362.01 (diabetic retinopathy NOS), and 362.07 (diabetic macular edema). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.