2027 ICD-10-CM Diagnosis Code E13.36Other specified diabetes mellitus with diabetic cataract
ICD-10-CM Codes›E00–E89›E08-E13›E13
- Billable — Valid for Submission
- Risk Adjusts — HCC 37
- Chronic Condition
E13.36 is a billable ICD-10-CM diagnosis code for other specified diabetes mellitus with diabetic cataract. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 8, 10, 19, 124 through 125. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cataract and other lens disorders; Diabetes mellitus with complication; and Diabetes mellitus, due to underlying condition, drug or chemical induced, or other specified type.
For Medicare Advantage risk adjustment, E13.36 maps to CMS-HCC Category 37 (Diabetes with Chronic Complications) under the V28 model, adding a risk factor of about 0.166 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when E13.36 is part of the patient record.
Diabetes: Glycemic Status Assessment Greater Than 9%
High Priority: YES
Measure Type: Intermediateoutcome
Submission Methods: Claims, Electronic Health Record, Registry
Description: Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.
Medicare Risk Adjustment (HCC)Billing
E13.36 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
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 2027, published by CMS and the National Center for Health Statistics.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to E13.36: its own notes plus those printed at E13 and Chapter 4. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- diabetes mellitus due to genetic defects of beta-cell function
- diabetes mellitus due to genetic defects in insulin action
- postpancreatectomy diabetes mellitus
- postprocedural diabetes mellitus
- secondary diabetes mellitus NEC
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- diabetes (mellitus) due to autoimmune process (E10.-)
- diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- type 1 diabetes mellitus (E10.-)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Notes
General instructions on how these codes are used.
- 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.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name E13.36, its category, or a range that includes it.
Excludes1 15
These codes carry an Excludes1 note naming E13.36: they are not reported together with it, unless the two conditions are unrelated.
- H28 Cataract in diseases classified elsewherecataract in diabetes mellitus (E08.36, E09.36, E10.36, E11.36, E13.36)
- E08 Diabetes mellitus due to underlying conditionpostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E08 Diabetes mellitus due to underlying conditionpostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E08 Diabetes mellitus due to underlying conditionsecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E87.2 Acidosisdiabetic acidosis - see categories E08-E10, E11, E13 with ketoacidosis names E13, which includes this code
- H36 Retinal disorders in diseases classified elsewherediabetic retinopathy (E08.3-, E09.3-, E10.3-, E11.3-, E13.3-) names E13.3-, which includes this code
Excludes2 2
These codes carry an Excludes2 note naming E13.36: its condition is not part of those codes, and both may be reported when the patient has both.
- E87.0 Hyperosmolality and hypernatremiadiabetes with hyperosmolarity (E08, E09, E11, E13 with final characters .00 or .01) names E13, which includes this code
- Chapter 7 (H00-H59) Diseases of the eye and adnexadiabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-) names E13.3-, which includes this code
Code First 1
These codes say to code first a condition named in the note, and E13.36 is one of the conditions named.
Use Additional Code 3
These codes say to use an additional code from the note, and E13.36 is one of the codes named.
- O24.8 Other pre-existing diabetes mellitus in pregnancy, childbirth, and the puerperiumfrom categories E08, E09 and E13 to further identify any manifestation names E13, which includes this code
- O24.9 Unspecified diabetes mellitus in pregnancy, childbirth and the puerperiumfrom categories E08, E09 and E13 to further identify any manifestation names E13, which includes this code
- Z90.41 Acquired absence of pancreasdiabetes mellitus, postpancreatectomy (E13.-) names E13.-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Cataract
A cataract is a clouding of the clear lens inside your eye. This cloudiness blocks light from reaching the back of the eye, making it harder to see clearly. A cataract can affect one or both eyes, but it doesn't spread from one eye to the other.
The full article covers:
- What are cataracts?
- What causes cataracts?
- Who is more likely to develop cataracts?
- What are the symptoms of cataracts?
- How are cataracts diagnosed?
- How are cataracts treated?
- Can cataracts be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert E13.36 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About E13.36Overview
What is the ICD-10 code for other specified diabetes mellitus with diabetic cataract?
The ICD-10-CM code for other specified diabetes mellitus with diabetic cataract is E13.36 (sometimes written as E1336). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is E13.36 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other specified diabetes mellitus with diabetic cataract on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does E13.36 group to?
When other specified diabetes mellitus with diabetic cataract is the principal diagnosis on an inpatient stay, it groups to MS-DRG 125, 8, 10, 19, 124, with relative weights from 0.7699 to 7.5461 depending on complications. Higher weights mean higher Medicare reimbursement.
Can E13.36 be reported with a code from E10?
Not as a rule. The Excludes1 note at E13, which applies to E13.36, lists "diabetes (mellitus) due to autoimmune process (E10.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
Does E13.36 need an additional code?
When the condition applies, yes. The Use Additional Code note at E13, which applies to E13.36, reads: 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). The additional code is reported after E13.36.
What HCC is E13.36?
E13.36 (other specified diabetes mellitus with diabetic cataract) maps to CMS-HCC Category 37 (Diabetes with Chronic Complications), commonly written as HCC 37, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 18 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 30.
Does E13.36 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, E13.36 adds a risk adjustment factor of about 0.166 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.166 to 0.280 depending on the payment segment). A more severe related category (HCC 35 and HCC 36) supersedes it when both are reported. See the full factor table on the HCC 37 category page.
