ICD-10 · PDGM grouping
E11 Type 2 diabetes mellitus
All 87 codes in the E11 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
87
Can lead a claim
73
Cannot lead a claim
14
What CMS assigns to E11
73 of the 87 codes group to MMTA - Endocrine (68), Wound (4) and Neuro Rehabilitation (1); 14 are assigned no clinical group. Comorbidity subgroups: 57 toward Type 1, Type 2, and Other Specified Diabetes; 13 toward Disease of the Macula and Blindness/Low Vision; 3 toward Diabetes with neuropathy; 14 are assigned none. 73 of the 87 can lead a claim.
- Type 1, Type 2, and Other Specified Diabetes: counts toward the high comorbidity tier only in an interaction pair.
- Disease of the Macula and Blindness/Low Vision
- Diabetes with neuropathy: can award the low comorbidity tier as a secondary diagnosis.
Every code in E11
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| E11.0 Type 2 diabetes mellitus with hyperosmolarity | ||||
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)CMS: Type 2 diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC) | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.1 Type 2 diabetes mellitus with ketoacidosis | ||||
| E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.2 Type 2 diabetes mellitus with kidney complications | ||||
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney diseaseCMS: Type 2 diabetes mellitus w diabetic chronic kidney disease | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complicationCMS: Type 2 diabetes mellitus w oth diabetic kidney complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3 Type 2 diabetes mellitus with ophthalmic complications | ||||
| E11.31 Type 2 diabetes mellitus with unspecified diabetic retinopathy | ||||
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edemaCMS: Type 2 diabetes w unsp diabetic retinopathy w macular edema | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edemaCMS: Type 2 diabetes w unsp diabetic rtnop w/o macular edema | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.32 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy | ||||
| E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema | ||||
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Type 2 diab with mild nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Type 2 diab with mild nonp rtnop with macular edema, l eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Type 2 diabetes with mild nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Type 2 diab with mild nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | ||||
| E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Type 2 diab with mild nonp rtnop without mclr edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Type 2 diab with mild nonp rtnop without mclr edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Type 2 diab with mild nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Type 2 diab with mild nonp rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.33 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy | ||||
| E11.331 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema | ||||
| E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Type 2 diab with mod nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Type 2 diab with mod nonp rtnop with macular edema, l eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Type 2 diab with moderate nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Type 2 diab with mod nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.339 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema | ||||
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Type 2 diab with mod nonp rtnop without macular edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Type 2 diab with mod nonp rtnop without macular edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Type 2 diab with mod nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Type 2 diab with mod nonp rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.34 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy | ||||
| E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema | ||||
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Type 2 diab with severe nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Type 2 diab with severe nonp rtnop with macular edema, l eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Type 2 diab with severe nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Type 2 diab with severe nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema | ||||
| E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Type 2 diab with severe nonp rtnop without mclr edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Type 2 diab with severe nonp rtnop without mclr edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Type 2 diab with severe nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Type 2 diab with severe nonp rtnop without mclr edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.35 Type 2 diabetes mellitus with proliferative diabetic retinopathy | ||||
| E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema | ||||
| E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eyeCMS: Type 2 diab with prolif diab rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eyeCMS: Type 2 diab with prolif diab rtnop with macular edema, l eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateralCMS: Type 2 diab with prolif diab rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Type 2 diab with prolif diab rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.352 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula | ||||
| E11.3521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eyeCMS: Type 2 diab w prolif diab rtnop w trctn dtch macula, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eyeCMS: Type 2 diab w prolif diab rtnop w trctn dtch macula, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateralCMS: Type 2 diab w prolif diab rtnop with trctn dtch macula, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eyeCMS: Type 2 diab w prolif diab rtnop with trctn dtch macula, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.353 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula | ||||
| E11.3531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eyeCMS: Type 2 diab w prolif diab rtnop w trctn dtch n-mcla, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eyeCMS: Type 2 diab w prolif diab rtnop w trctn dtch n-mcla, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateralCMS: Type 2 diab w prolif diab rtnop with trctn dtch n-mcla, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eyeCMS: Type 2 diab w prolif diab rtnop with trctn dtch n-mcla, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.354 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment | ||||
| E11.3541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eyeCMS: Type 2 diab with prolif diab rtnop with comb detach, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eyeCMS: Type 2 diab with prolif diab rtnop with comb detach, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateralCMS: Type 2 diab with prolif diabetic rtnop with comb detach, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eyeCMS: Type 2 diab with prolif diab rtnop with comb detach, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.355 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy | ||||
| E11.3551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eyeCMS: Type 2 diabetes with stable prolif diabetic rtnop, right eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eyeCMS: Type 2 diabetes with stable prolif diabetic rtnop, left eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateralCMS: Type 2 diabetes with stable prolif diabetic rtnop, bilateral | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eyeCMS: Type 2 diabetes with stable prolif diabetic rtnop, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema | ||||
| E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eyeCMS: Type 2 diab with prolif diab rtnop without mclr edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eyeCMS: Type 2 diab with prolif diab rtnop without mclr edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateralCMS: Type 2 diab with prolif diab rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Type 2 diab with prolif diab rtnop without mclr edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.37 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment | ||||
| E11.37X1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eyeCMS: Type 2 diab with diab mclr edema, resolved fol trtmt, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.37X2 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eyeCMS: Type 2 diab with diab mclr edema, resolved fol trtmt, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.37X3 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateralCMS: Type 2 diab with diab macular edema, resolved fol trtmt, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.37X9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eyeCMS: Type 2 diab with diab mclr edema, resolved fol trtmt, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complicationCMS: Type 2 diabetes w oth diabetic ophthalmic complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.4 Type 2 diabetes mellitus with neurological complications | ||||
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecifiedCMS: Type 2 diabetes mellitus with diabetic neuropathy, unsp | Can lead a claim | I | Diabetes with neuropathy |
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | Can lead a claim | I | Diabetes with neuropathy |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathyCMS: Type 2 diabetes w diabetic autonomic (poly)neuropathy | Can lead a claim | I | Diabetes with neuropathy |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complicationCMS: Type 2 diabetes w oth diabetic neurological complication | Can lead a claim | B | Type 1, Type 2, and Other Specified Diabetes |
| E11.5 Type 2 diabetes mellitus with circulatory complications | ||||
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangreneCMS: Type 2 diabetes w diabetic peripheral angiopath w/o gangrene | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangreneCMS: Type 2 diabetes w diabetic peripheral angiopathy w gangrene | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E11.59 | Type 2 diabetes mellitus with other circulatory complicationsCMS: Type 2 diabetes mellitus with oth circulatory complications | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.6 Type 2 diabetes mellitus with other specified complications | ||||
| E11.61 Type 2 diabetes mellitus with diabetic arthropathy | ||||
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathyCMS: Type 2 diabetes mellitus w diabetic neuropathic arthropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.62 Type 2 diabetes mellitus with skin complications | ||||
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.621 | Type 2 diabetes mellitus with foot ulcer | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E11.628 | Type 2 diabetes mellitus with other skin complications | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E11.63 Type 2 diabetes mellitus with oral complications | ||||
| E11.630 | Type 2 diabetes mellitus with periodontal disease | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.638 | Type 2 diabetes mellitus with other oral complications | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.64 Type 2 diabetes mellitus with hypoglycemia | ||||
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.69 | Type 2 diabetes mellitus with other specified complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.8 | Type 2 diabetes mellitus with unspecified complications | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E11.9 | Type 2 diabetes mellitus without complications | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E11.A | Type 2 diabetes mellitus without complications in remission | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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