ICD-10 Code E11.359 – Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E11.359 – Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
What it is
This code identifies type 2 diabetes complicated by proliferative diabetic retinopathy, with no macular edema documented. Use it when the record shows advanced retinal neovascular changes linked to diabetes.
Clinical signs
Findings may include retinal neovascularization, vitreous hemorrhage, or tractional changes on eye examination. Clinical features vary; refer to documentation.
When to use this code
Use this code when the provider documents type 2 diabetes and proliferative diabetic retinopathy, and specifically states that macular edema is absent. It fits ophthalmology notes, problem lists, or discharge summaries that clearly link the eye disease to diabetes. Check documentation if the eye findings are not specific.
Do not use for
Do not use this code if macular edema is present, or if the retinopathy is nonproliferative or unspecified. Also avoid it when diabetes type is not documented clearly.
Coding tip
Confirm both the diabetes type and the “without macular edema” wording before assigning E11.359.