E11.52 vs I70.261: There Is No Code-First Row
There is no Code First instruction on E11.52 or I70.261. Desk table for diabetic vs atherosclerotic gangrene: E11.52 maps to V28 HCC 37 and 263, I70.261 maps to 263 only, and 263 pays once if both codes are on the encounter.
By the HCC Buddy Coding Team
Updated: September 5, 2026
There is no Code First instruction on E11.52 or I70.261. The leftover search lands on the I70.261 card. That card does not tell you to code E11.52 first. The E11.52 card does not tell you to add I70.261.
Open the live E11.52, E11.51, and I70.261 cards before you invent a sequencing row. This page is the desk table for that leftover. It is not a rewrite of the I70.209 PAD desk. It is not an ulcer walk. It is not a model-update story.
*Current as of August 25, 2026. V28 mapping and CNA factors come from the live code pages named below and the 2026 Final ICD-10-CM Mappings. Payment year 2026 is 100% V28. Look the exact codes up. Do not code from this recap. Do not invent a Code First row.*
Quick answer
Pick the code the etiology supports.
| Code | What the row is naming | V28 payment HCC | CNA |
|---|---|---|---|
| E11.52 | Type 2 DM with diabetic peripheral angiopathy WITH gangrene | HCC 37 and HCC 263 | 0.166 and 1.118 |
| E11.51 | Type 2 DM with diabetic peripheral angiopathy WITHOUT gangrene | HCC 37 only | 0.166 |
| I70.261 | atherosclerosis of native arteries with gangrene, right leg | HCC 263 only | 1.118 |
If both etiologies apply, assign E11.52 and I70.26x. Payment is 37 + 263. 263 pays once. Do not stack 263.
Do not use I96 in place of the combination the record supports.
There is no Code First row
On the FY2026 Apr cards:
Sequencing is etiology, not a hidden Code First.
Diabetic gangrene vs atherosclerotic gangrene
Diabetic gangrene: the E11.52 inclusion term is Type 2 diabetes mellitus with diabetic gangrene. Do not replace it with I96. Do not use I70.261 instead of E11.52 for diabetic gangrene.
Atherosclerotic native-artery gangrene: I70.261, laterality in the code. If both etiologies apply, E11.52 plus I70.26x additional. That is not a Code First.
Do not query to add I70.261 when the note only has diabetic gangrene. Do not query to add E11.52 when the note only has atherosclerotic PAD with gangrene and no diabetes-with-angiopathy assessment.
263 pays once
E11.52 already maps to HCC 37 and HCC 263. I70.261 maps to HCC 263 only. If both codes are on the encounter, 263 pays once. Do not stack 263.
Do not add I70.261 just to get 263. E11.52 already carries it.
Combination-code mechanics sit on the combination-codes post. The unspecified PAD payment leftover sits on the I70.209 desk. This page does not rewrite either walk.
Review documentation support
Do not downcode E11.52 to E11.51 when gangrene is documented. Do not downcode I70.261 to I70.23x when gangrene is documented.
A problem-list row from last year is not enough. An HCC mapping does not establish reportability. Review the full eligible record and apply the official coding, encounter, program and payer requirements. See MEAT criteria and problem lists do not validate HCCs. MEAT is the training mnemonic. The authorities are the Official Guidelines and the record from the date of service.
Common misses
1. Inventing a Code First row. The leftover search lands on I70.261. That card does not tell you to code E11.52 first.
2. Coding I70.261 instead of E11.52 for diabetic gangrene. E11.52 is the combination when the record supports Type 2 DM with diabetic peripheral angiopathy with gangrene.
3. Adding I70.261 just to get 263. E11.52 already maps to 37 and 263.
4. Using I96. Do not use gangrene, not elsewhere classified, in place of the combination the record supports.
5. Stacking 263 twice. Both codes on the encounter still pay 263 once.
6. Treating E11.51 as 263. E11.51 is HCC 37 only. Do not downcode E11.52 to E11.51 when gangrene is documented.
Two-minute check
1. Name the etiology the provider assessed today: diabetic peripheral angiopathy with gangrene, diabetic peripheral angiopathy without gangrene, atherosclerotic native-artery gangrene, or both.
2. Assign the ICD-10-CM code the record supports. Do not invent a Code First row.
3. Look that exact code up on HCC Buddy or in the encoder.
4. If both etiologies apply, assign E11.52 and I70.26x. Expect 37 + 263. Do not stack 263.
5. Review documentation support under the applicable official rules. Do not downcode E11.52 to E11.51, or I70.261 to I70.23x, when gangrene is documented.
Related
Disclaimer
This article is for professional and educational use only. It is not coding, billing, legal, or medical advice. Verify every code, HCC map, and guideline section against current official CMS and ICD-10-CM guidance and your payer's policy before you assign it. Reading it creates no provider, patient, or advisory relationship.
By the HCC Buddy Coding Team. V28 mappings and CNA factors from the cited live code pages (CMS-HCC V28 PY2026 model software and ICD-10-CM mapping file). Not medical advice. Not a CMS-HCC model change beyond V28. Not an IPPS or NCD story.
Sources
E11.52 (V28 HCC 37 CNA 0.166 and HCC 263 CNA 1.118; no Code First, no Use Additional, no Code Also; inclusion Type 2 diabetes mellitus with diabetic gangrene)
E11.51 (V28 HCC 37 CNA 0.166)
I70.261 (V28 HCC 263 CNA 1.118; no Code First; Use Additional L97.- / L98.49- if applicable)
Related Tools
E11.52 card
V28 HCC 37 and HCC 263. Confirm the live card before you invent a Code First row.
I70.261 card
V28 HCC 263 only. No Code First. Use Additional is L97.- / L98.49- if an ulcer is present.
E11.51 card
Type 2 DM with diabetic peripheral angiopathy without gangrene. HCC 37 only. Not 263.
Combination codes
Combination-code mechanics. This post is the E11.52 / I70.261 sequencing leftover.
I70.209 PAD desk
Unspecified PAD payment leftover. This post is the gangrene sequencing leftover.
Encoder
Look up the exact E11.5x or I70.26x the record supports.
HCC Buddy Coding Team
Editorial
Every HCC Buddy article is checked against the current CMS-HCC model and the active FY ICD-10-CM tabular release before it publishes.
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