ICD-10 Code E11.331 – Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E11.331 – Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
What it is
This code identifies type 2 diabetes complicated by moderate nonproliferative diabetic retinopathy and macular edema. It means diabetic eye damage is present, with swelling involving the macula.
Clinical signs
Findings may include retinal microaneurysms, hemorrhages, cotton-wool spots, and venous changes consistent with moderate nonproliferative retinopathy. Macular edema is documented when the macula is swollen or thickened; clinical features vary, refer to documentation.
When to use this code
Use this code when the provider documents type 2 diabetes and specifically states moderate nonproliferative diabetic retinopathy with macular edema. It is appropriate for ophthalmology, endocrinology, or primary care notes that confirm this exact complication. Check documentation if severity or laterality is unclear.
Do not use for
Do not use this code for diabetic retinopathy without macular edema, or for proliferative retinopathy. If the record only says “diabetic eye disease” or gives a different severity, choose the documented code.
Coding tip
Code only when the provider links the retinopathy and macular edema to type 2 diabetes and documents the severity clearly.