ICD-10 Code E13.351 – Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E13.351 – Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema
What it is
This code identifies diabetes mellitus of another specified type with proliferative diabetic retinopathy and macular edema in the same eye or eyes. Use it when the record clearly links these retinal complications to the specified diabetes category.
Clinical signs
Proliferative diabetic retinopathy involves abnormal retinal blood vessel growth, and macular edema means fluid-related swelling in the macula. Clinical features vary; refer to documentation for ophthalmology findings or imaging confirmation.
When to use this code
Use E13.351 when the provider documents other specified diabetes mellitus and confirms proliferative diabetic retinopathy with macular edema. Apply it for encounters focused on diabetic eye disease, including follow-up visits where both complications remain active. Check documentation if laterality or severity details are unclear.
Do not use for
Do not use this code if the record does not specify the diabetes type as “other specified” or if retinopathy is nonproliferative only. Do not assign it when macular edema is absent or undocumented.
Coding tip
Verify both components—proliferative retinopathy and macular edema—before coding, and confirm the diabetes category matches “other specified diabetes mellitus.”