2025 ICD-10-CM code E11.36
(Active) Effective Date: N/A Endocrine, Nutritional and Metabolic Diseases - Diabetes mellitus 4 Feed
Type 2 diabetes mellitus with diabetic cataract.
Medical necessity for services related to the cataract will be supported by the diagnosis of a diabetic cataract, as it impacts visual function. The diagnosis of type 2 diabetes supports medical necessity for diabetes management.
Clinicians should document the connection between diabetes and the cataract.They should also assess and document the severity and impact of the cataract on the patient’s vision. The laterality (right, left, bilateral) needs additional characters in ICD-10-CM coding after E11.36 to fully specify the diagnosis. General diabetes management, eye exams, and possible surgical intervention for the cataract are typical responsibilities.
In simple words: This code indicates that a person has type 2 diabetes, and they also have a cataract (a clouding of the lens in their eye) which is a result of the diabetes.
Type 2 diabetes mellitus with diabetic cataract. This code signifies a patient has type 2 diabetes and a cataract that developed due to the diabetes.It is important to distinguish between this and a patient who simply has both type 2 diabetes and a cataract unrelated to the diabetes.This diagnosis requires clear documentation of the causal link between the diabetes and cataract.
Example 1: A 60-year-old patient with a long history of type 2 diabetes presents with blurred vision. Upon examination, a diabetic cataract is diagnosed in their right eye. The diagnosis is E11.361 (right eye)., A 75-year-old with type 2 diabetes controlled with medication is diagnosed with cataracts in both eyes, determined to be caused by the diabetes.The diagnosis code is E11.363 (bilateral)., A patient with type 2 diabetes has a cataract removed.If the documentation clearly links the cataract to the diabetes, E11.36 is still reported, even after cataract surgery.
Documentation must clearly state the type of diabetes (type 2) and confirm the cataract is diabetic in origin.The affected eye(s) should also be clearly documented. The physician’s notes must support the cause-and-effect relationship.
- Specialties:Endocrinology, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital