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ICD-10-CM E13.3313: Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral

E13.3313 is the billable ICD-10-CM code for other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral, in category E13 (Other specified diabetes mellitus) of the Diabetes mellitus section. As a principal diagnosis it groups to MS-DRG 008 Simultaneous Pancreas, Islet Cell and Kidney Transplant, MS-DRG 010 Pancreas or Islet Cell Transplant, MS-DRG 019 Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis (MDC PRE Pre-MDC (transplants, tracheostomy, ECMO)); or MS-DRG 124 Other Disorders of the Eye with MCC or Thrombolytic Agent, MS-DRG 125 Other Disorders of the Eye without MCC (MDC 02 MDC 02: Diseases and Disorders of the Eye). It maps to HCC 37 (Diabetes with Chronic Complications) and HCC 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) in CMS-HCC V28. 53 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
E13.3313
billable FY2027 ICD-10-CM code
Category
E13 Other specified diabetes mellitus
Chapter
4: Endocrine, nutritional and metabolic diseases (E00-E89)
CC/MCC (MS-DRG v44)
Neither
CMS-HCC V28
HCC 37, HCC 298
POA reporting
Required

Tabular list notes for E13.3313

The tabular list has no notes on E13.3313 itself; the notes below apply from its parent headings.

Inherited from E13 (Other specified diabetes mellitus)

Includes
  • diabetes mellitus due to genetic defects of beta-cell function
  • diabetes mellitus due to genetic defects in insulin action
  • postpancreatectomy diabetes mellitus
  • postprocedural diabetes mellitus
  • secondary diabetes mellitus NEC
Excludes1 (never coded together)
  • diabetes (mellitus) due to autoimmune process (E10.-)
  • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
  • diabetes mellitus due to underlying condition (E08.-)
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • neonatal diabetes mellitus (P70.2)
  • type 1 diabetes mellitus (E10.-)
Use additional code
  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)
  • oral hypoglycemic drugs (Z79.84)

The 7th character 3 means “bilateral”, as defined at E13.33. The same injury coded for a later encounter uses a different 7th character, so check each encounter.

MS-DRG grouping when E13.3313 is the principal diagnosis

MS-DRG v44 groups for E13.3313 as principal diagnosis
MDCMS-DRGs
PRE Pre-MDC (transplants, tracheostomy, ECMO)008010019
02 MDC 02: Diseases and Disorders of the Eye124125

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for E13.3313 shows the full grouping logic.

CC/MCC status and inpatient edits

E13.3313 is neither a CC nor an MCC under MS-DRG v44, so as a secondary diagnosis it does not raise the MS-DRG severity level. Check E13.3313 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, E13.3313 maps to HCC 37 (Diabetes with Chronic Complications), HCC 298 (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list E13.3313

53 current Medicare billing and coding articles list E13.3313 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM E13.3313 mean?

E13.3313 means other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral. It is one of 25 billable codes under E13, other specified diabetes mellitus.

Which MS-DRG does E13.3313 group to?

As the principal diagnosis, E13.3313 groups to MS-DRG 008 Simultaneous Pancreas, Islet Cell and Kidney Transplant, MS-DRG 010 Pancreas or Islet Cell Transplant, MS-DRG 019 Simultaneous Pancreas, Islet Cell and Kidney Transplant with Hemodialysis (MDC PRE Pre-MDC (transplants, tracheostomy, ECMO)); or MS-DRG 124 Other Disorders of the Eye with MCC or Thrombolytic Agent, MS-DRG 125 Other Disorders of the Eye without MCC (MDC 02 MDC 02: Diseases and Disorders of the Eye) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does E13.3313 map to an HCC?

Yes: HCC 37, Diabetes with Chronic Complications; HCC 298, Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage, in the PY2027 CMS-HCC V28 mapping.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.