2026 ICD-10-CM Diagnosis Code E11.3219Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

ICD-10-CM Codes›E00–E89›E08-E13›E11

ICD-10-CM E11.3219
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

E11.3219 is a billable ICD-10-CM diagnosis code for type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye. The 7th character 9 reports diabetic eye disease in an unspecified eye. 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
E11.3219
Billable Status
Yes — Valid for Submission
Code Describes
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye
Short Description
Type 2 diab with mild nonp rtnop with macular edema, unsp
Parent Code
E11.321
Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema

Code Classification

ChapterE00–E89Endocrine, nutritional and metabolic diseases
SectionE08-E13Diabetes mellitus
CategoryE11Type 2 diabetes mellitus
This CodeE11.3219Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when E11.3219 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

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.

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 E11.3219 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
362.04 Mild nonprolf db retnoph
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 History & ChangesHistory

Replacement E11.3219 replaces the following previously assigned code(s):

  • E11.321 - Type 2 diab w mild nonprlf diabetic rtnop w macular edema
FY 2018AddedAdded to the ICD-10-CM code setEffective October 1, 2017.
FY 2019–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About E11.3219Overview

Is E11.3219 a billable code?

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

What does the 7th character 9 in E11.3219 mean?

The final character 9 reports diabetic eye disease in an unspecified eye, in this case involving the type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema.

What MS-DRG does E11.3219 group to?

When type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye 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 E11.3219?

Under the General Equivalence Mappings, type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye converts to ICD-9-CM 250.50 (DMII ophth nt st uncntrl), 362.04 (mild nonprolf db retnoph), 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.