ICD-10 · PDGM grouping
E13 Other specified diabetes mellitus
All 86 codes in the E13 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
86
Can lead a claim
71
Cannot lead a claim
15
What CMS assigns to E13
71 of the 86 codes group to MMTA - Endocrine (66), Wound (4) and MMTA - Other (1); 15 are assigned no clinical group. Comorbidity subgroups: 56 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. 71 of the 86 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 E13
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 |
|---|---|---|---|---|
| E13.0 Other specified diabetes mellitus with hyperosmolarity | ||||
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)CMS: Oth diab w hyprosm w/o nonket hyprgly-hypros coma (NKHHC) | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with comaCMS: Oth diabetes mellitus with hyperosmolarity with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.1 Other specified diabetes mellitus with ketoacidosis | ||||
| E13.10 | Other specified diabetes mellitus with ketoacidosis without comaCMS: Oth diabetes mellitus with ketoacidosis without coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.11 | Other specified diabetes mellitus with ketoacidosis with comaCMS: Oth diabetes mellitus with ketoacidosis with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.2 Other specified diabetes mellitus with kidney complications | ||||
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney diseaseCMS: Oth diabetes mellitus with diabetic chronic kidney disease | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complicationCMS: Oth diabetes mellitus with oth diabetic kidney complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3 Other specified diabetes mellitus with ophthalmic complications | ||||
| E13.31 Other specified diabetes mellitus with unspecified diabetic retinopathy | ||||
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edemaCMS: Oth diabetes w unsp diabetic retinopathy w macular edema | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edemaCMS: Oth diabetes w unsp diabetic retinopathy w/o macular edema | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.32 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy | ||||
| E13.321 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema | ||||
| E13.3211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Oth diabetes with mild nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Oth diab with mild nonp rtnop with macular edema, left eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Oth diabetes with mild nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Oth diabetes with mild nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.329 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | ||||
| E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Oth diab with mild nonp rtnop without macular edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3292 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Oth diab with mild nonp rtnop without macular edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3293 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Oth diabetes with mild nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3299 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Oth diab with mild nonp rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.33 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy | ||||
| E13.331 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema | ||||
| E13.3311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Oth diab with moderate nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Oth diab with moderate nonp rtnop with macular edema, l eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Oth diabetes with moderate nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Oth diab with moderate nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.339 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema | ||||
| E13.3391 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Oth diab with mod nonp rtnop without macular edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Oth diab with mod nonp rtnop without macular edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Oth diab with moderate nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Oth diab with mod nonp rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.34 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy | ||||
| E13.341 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema | ||||
| E13.3411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eyeCMS: Oth diab with severe nonp rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eyeCMS: Oth diab with severe nonp rtnop with macular edema, left eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateralCMS: Oth diabetes with severe nonp rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Oth diabetes with severe nonp rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.349 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema | ||||
| E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eyeCMS: Oth diab with severe nonp rtnop without macular edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3492 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eyeCMS: Oth diab with severe nonp rtnop without macular edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3493 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateralCMS: Oth diab with severe nonp rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3499 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Oth diab with severe nonp rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.35 Other specified diabetes mellitus with proliferative diabetic retinopathy | ||||
| E13.351 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema | ||||
| E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eyeCMS: Oth diab with prolif diab rtnop with macular edema, r eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eyeCMS: Oth diab with prolif diab rtnop with macular edema, left eye | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateralCMS: Oth diab with prolif diabetic rtnop with macular edema, bi | Can lead a claim | I | Disease of the Macula and Blindness/Low Vision |
| E13.3519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eyeCMS: Oth diab with prolif diabetic rtnop with macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.352 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula | ||||
| E13.3521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eyeCMS: Oth diab w prolif diab rtnop with trctn dtch macula, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3522 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eyeCMS: Oth diab w prolif diab rtnop with trctn dtch macula, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3523 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateralCMS: Oth diab with prolif diab rtnop with trctn dtch macula, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3529 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eyeCMS: Oth diab with prolif diab rtnop with trctn dtch macula, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.353 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula | ||||
| E13.3531 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eyeCMS: Oth diab w prolif diab rtnop with trctn dtch n-mcla, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3532 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eyeCMS: Oth diab w prolif diab rtnop with trctn dtch n-mcla, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3533 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateralCMS: Oth diab with prolif diab rtnop with trctn dtch n-mcla, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3539 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eyeCMS: Oth diab with prolif diab rtnop with trctn dtch n-mcla, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.354 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment | ||||
| E13.3541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eyeCMS: Oth diab with prolif diabetic rtnop with comb detach, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3542 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eyeCMS: Oth diab with prolif diab rtnop with comb detach, left eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3543 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateralCMS: Oth diabetes with prolif diabetic rtnop with comb detach, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3549 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eyeCMS: Oth diab with prolif diabetic rtnop with comb detach, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.355 Other specified diabetes mellitus with stable proliferative diabetic retinopathy | ||||
| E13.3551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eyeCMS: Oth diabetes with stable prolif diabetic rtnop, right eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3552 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eyeCMS: Oth diabetes with stable prolif diabetic rtnop, left eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3553 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateralCMS: Oth diabetes with stable prolif diabetic rtnop, bilateral | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3559 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eyeCMS: Oth diabetes with stable prolif diabetic retinopathy, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.359 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema | ||||
| E13.3591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eyeCMS: Oth diab with prolif diab rtnop without macular edema, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eyeCMS: Oth diab with prolif diab rtnop without macular edema, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateralCMS: Oth diab with prolif diab rtnop without macular edema, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eyeCMS: Oth diab with prolif diab rtnop without macular edema, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.36 | Other specified diabetes mellitus with diabetic cataract | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.37 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment | ||||
| E13.37X1 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eyeCMS: Oth diab with diab macular edema, resolved fol trtmt, r eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.37X2 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eyeCMS: Oth diab with diab macular edema, resolved fol trtmt, l eye | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.37X3 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateralCMS: Oth diab with diabetic macular edema, resolved fol trtmt, bi | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.37X9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eyeCMS: Oth diab with diab macular edema, resolved fol trtmt, unsp | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complicationCMS: Oth diabetes mellitus w oth diabetic ophthalmic complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.4 Other specified diabetes mellitus with neurological complications | ||||
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecifiedCMS: Oth diabetes mellitus with diabetic neuropathy, unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | Diabetes with neuropathy |
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathyCMS: Oth diabetes mellitus with diabetic mononeuropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathyCMS: Oth diabetes mellitus with diabetic polyneuropathy | Can lead a claim | I | Diabetes with neuropathy |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathyCMS: Oth diabetes mellitus w diabetic autonomic (poly)neuropathy | Can lead a claim | I | Diabetes with neuropathy |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complicationCMS: Oth diabetes w oth diabetic neurological complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.5 Other specified diabetes mellitus with circulatory complications | ||||
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangreneCMS: Oth diabetes w diabetic peripheral angiopathy w/o gangrene | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangreneCMS: Oth diabetes w diabetic peripheral angiopathy w gangrene | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E13.59 | Other specified diabetes mellitus with other circulatory complicationsCMS: Oth diabetes mellitus with other circulatory complications | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.6 Other specified diabetes mellitus with other specified complications | ||||
| E13.61 Other specified diabetes mellitus with diabetic arthropathy | ||||
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathyCMS: Oth diabetes mellitus with diabetic neuropathic arthropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathyCMS: Oth diabetes mellitus with other diabetic arthropathy | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.62 Other specified diabetes mellitus with skin complications | ||||
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.621 | Other specified diabetes mellitus with foot ulcer | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E13.622 | Other specified diabetes mellitus with other skin ulcer | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E13.628 | Other specified diabetes mellitus with other skin complicationsCMS: Oth diabetes mellitus with other skin complications | Can lead a claim | C | Type 1, Type 2, and Other Specified Diabetes |
| E13.63 Other specified diabetes mellitus with oral complications | ||||
| E13.630 | Other specified diabetes mellitus with periodontal disease | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.638 | Other specified diabetes mellitus with other oral complicationsCMS: Oth diabetes mellitus with other oral complications | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.64 Other specified diabetes mellitus with hypoglycemia | ||||
| E13.641 | Other specified diabetes mellitus with hypoglycemia with comaCMS: Oth diabetes mellitus with hypoglycemia with coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.649 | Other specified diabetes mellitus with hypoglycemia without comaCMS: Oth diabetes mellitus with hypoglycemia without coma | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.65 | Other specified diabetes mellitus with hyperglycemia | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.69 | Other specified diabetes mellitus with other specified complicationCMS: Oth diabetes mellitus with other specified complication | Can lead a claim | I | Type 1, Type 2, and Other Specified Diabetes |
| E13.8 | Other specified diabetes mellitus with unspecified complicationsCMS: Oth diabetes mellitus with unspecified complications | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| E13.9 | Other specified diabetes mellitus without complications | Can lead a claim | A | 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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