ICD-10 Code E13.359 – Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E13.359 – Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema
What it is
This code identifies diabetes mellitus in the “other specified” category with proliferative diabetic retinopathy, but no macular edema. It signals advanced retinal damage from diabetes that has not yet caused swelling in the macula.
Clinical signs
Findings may include retinal neovascularization, vitreous hemorrhage, or tractional retinal changes on eye examination. Clinical features vary; refer to documentation.
When to use this code
Use this code when the provider documents diabetes in the other specified category and specifically states proliferative diabetic retinopathy without macular edema. It applies when the retinopathy is linked to the diabetes diagnosis and macular edema is absent. Check documentation if the type of diabetes or eye complication is unclear.
Do not use for
Do not use this code if macular edema is documented, or if the retinopathy is nonproliferative. Do not assign it when the record does not specify the diabetes category or the retinal complication.
Coding tip
Confirm both the diabetes category and the exact eye complication before coding; the absence of macular edema matters.