2026 ICD-10-CM Diagnosis Code E13.3212Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

ICD-10-CM Codes›E00–E89›E08-E13›E13

ICD-10-CM E13.3212
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

E13.3212 is a billable ICD-10-CM diagnosis code for other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye. The 7th character 2 reports diabetic eye disease affecting the left 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, due to underlying condition, drug or chemical induced, or other specified type; and Retinal and vitreous conditions.

Code Identity

ICD-10-CM Code
E13.3212
Billable Status
Yes — Valid for Submission
Code Describes
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
Short Description
Oth diab with mild nonp rtnop with macular edema, left eye
Parent Code
E13.321
Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema

Code Classification

ChapterE00–E89Endocrine, nutritional and metabolic diseases
SectionE08-E13Diabetes mellitus
CategoryE13Other specified diabetes mellitus
This CodeE13.3212Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye

Quality Payment Program MeasuresBilling

Medicare quality measures that can apply when E13.3212 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.

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 END006
Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type
Default principal diagnosis: inpatient No · outpatient No
CCSR EYE005
Retinal and vitreous conditions
Default principal diagnosis: inpatient No · outpatient No

Patient EducationClinical

Diabetes

Diabetes, also known as diabetes mellitus, is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your body's main source of energy. Your body can make glucose, but it also comes from the food you eat. Insulin is a hormone made by your pancreas.

The full article covers:

  • What is diabetes?
  • What are the types of diabetes?
  • What causes diabetes?
  • Who is more likely to develop diabetes?
  • What are the symptoms of diabetes?
  • How is diabetes diagnosed?
  • What are the treatments for diabetes?
  • Can diabetes be prevented?

Read the full article at MedlinePlus

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

Convert E13.3212 to ICD-9-CMHistory

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

ICD-9-CM
249.50 Sec DM ophth nt st uncn
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
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 E13.3212 replaces the following previously assigned code(s):

  • E13.321 - Oth diabetes 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 E13.3212Overview

Is E13.3212 a billable code?

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

What does the 7th character 2 in E13.3212 mean?

The final character 2 reports diabetic eye disease affecting the left eye, in this case involving the other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema.

What MS-DRG does E13.3212 group to?

When other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left 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 E13.3212?

Under the General Equivalence Mappings, other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye converts to ICD-9-CM 249.50 (sec DM ophth nt st uncn), 250.50 (DMII ophth nt st uncntrl), and 362.04 (mild nonprolf db retnoph). 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.