ICD-10 Code E11.351 – Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E11.351 – Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema
What it is
This code identifies type 2 diabetes complicated by proliferative diabetic retinopathy and macular edema. It means diabetic eye disease has advanced enough to affect the retina and cause swelling in the macula.
Clinical signs
Typical findings include retinal neovascularization, hemorrhage, and macular swelling on eye examination or imaging. Vision may be blurred or reduced, but clinical features vary; refer to documentation.
When to use this code
Use E11.351 when the provider documents type 2 diabetes with both proliferative diabetic retinopathy and macular edema in the same eye or both eyes. Code it when the record clearly links the retinopathy to diabetes. If laterality or severity details are unclear, check documentation.
Do not use for
Do not use this code for diabetes without retinopathy, nonproliferative retinopathy, or macular edema from another cause. Do not assign it if proliferative disease or macular edema is not documented.
Coding tip
Confirm that the ophthalmology note explicitly states proliferative retinopathy with macular edema before assigning E11.351.