E11.3311: Type 2 diab with mod nonp rtnop with macular edema, r eye
Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye
Quick Clinical & Billing Summary
What is ICD-10-CM code E11.3311? E11.3311 represents Type 2 diab with mod nonp rtnop with macular edema, r eye. Under official CDC guidelines, this code is billable and specific for claim submission.
Code Hierarchy & Classification
Clinical Guidance & Documentation Standards
7th Character Episode of Care Builder
Chapter 19 RequirementICD-10-CM coding guidelines mandate assigning an appropriate 7th character for traumatic injuries, fractures, and external causes to denote the episode of care:
CMS-HCC Risk Adjustment Model
Diagnoses under category E11 map to the official CMS-HCC (Hierarchical Condition Category) risk adjustment model used for Medicare Advantage risk scoring.
Associated Procedures & Medicare RVU Reimbursement
Open RVU Calculator →Typical outpatient and office evaluation procedures frequently billed alongside diagnosis E11.3311:
| CPT/HCPCS | Description | Work RVU | Non-Facility Fee | Facility Fee |
|---|---|---|---|---|
| 99213 | Office/outpatient visit, established patient, 20-29 minutes (Low MDM) | 1.30 | $91.69 | $66.79 |
| 99214 | Office/outpatient visit, established patient, 30-39 minutes (Moderate MDM) | 1.92 | $133.61 | $100.21 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (subcutaneous/intramuscular) | 0.17 | $18.34 | $12.44 |
CPT Modifier & Billing Rules
Append when a significant, separately identifiable evaluation and management service is provided on the same calendar day as a minor surgical procedure or injection.
Identifies procedures or services not normally reported together but distinct under the clinical circumstances. Use CMS X-modifiers (XE, XS, XP, XU) where required by Medicare.
Frequently Asked Questions about E11.3311
Is E11.3311 a billable ICD-10 code?
Yes, E11.3311 is a valid, billable and specific ICD-10-CM code. It can be reported as a primary or secondary diagnosis on medical claims.
What is the ICD-10 code for Type 2 diab with mod nonp rtnop with macular edema, r eye?
The primary ICD-10-CM code for Type 2 diab with mod nonp rtnop with macular edema, r eye is E11.3311.
What is the effective date of the current E11.3311 code?
The code is active for fiscal year FY2027, effective starting 2026-10-01.
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