E11.65 Maps to HCC 38 in V28, Not HCC 37
E11.65 maps to V28 HCC 38 (CNA 0.166), the same bucket as E11.9. It does not map to HCC 37. Desk table for the leftover search pairing E11.65 with HCC 37.
By the HCC Buddy Coding Team
Updated: August 26, 2026
E11.65 maps to HCC 38. It does not map to HCC 37. The leftover search is "e11.65" "hcc 37" v28. That pairing is the miss.
Open the live E11.65, E11.9, and E11.22 cards before you invent a 37 row on the hyperglycemia code. This page is the desk table for that leftover. It is not a rewrite of the E11.22 desk. It is not the E11.52 leftover. It is not the I70.209 leftover.
*Current as of August 26, 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 V24 map.*
Quick answer
No. E11.65 does not map to HCC 37. On the live card it maps to CMS-HCC V28 HCC 38, Diabetes with No, Glycemic, or Unspecified Complications. The source-labeled community non-dual aged reference coefficient is 0.166.
| Code | What the row is naming | V28 payment HCC | CNA |
|---|---|---|---|
| E11.65 | Type 2 DM with hyperglycemia | HCC 38 | 0.166 |
| E11.9 | Type 2 DM without complications | HCC 38 | 0.166 |
| E11.22 | Type 2 DM with diabetic CKD | HCC 37 | 0.166 |
Hyperglycemia is a glycemic finding. It is not diabetic CKD, neuropathy, retinopathy, or angiopathy. HCC 37 is chronic complications. HCC 38 is no, glycemic, or unspecified. E11.65 sits in 38.
36, 37, and 38 share 0.166
V28 constrained HCC 36, HCC 37, and HCC 38 to the same 0.166 community coefficient. Moving E11.9 to E11.65 does not raise the diabetes dollar and does not open a second HCC.
The E11.22 desk is the chronic-complication plus N18 walk. This page is the 37-vs-38 leftover.
Do not invent a V24 map
The live E11.65 card shows no V24 mapping. Do not back-fill a V24 HCC.
What E11.65 needs
The provider must assess hyperglycemia this encounter. A standalone A1C is not enough.
Do not use E11.65 when the note supports ketoacidosis (E11.10 / E11.11) or hyperosmolarity (E11.00 / E11.01). Those map to HCC 36.
If the chart also supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). Hierarchy keeps one diabetes HCC. 37 supersedes 38.
E11.65 has no Code First and no Use Additional on the live card.
MEAT this year
Mapped codes still need monitoring, evaluation, assessment, or treatment this visit. A problem-list row from last year is not enough. 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. Reading with-hyperglycemia as HCC 37. E11.65 is HCC 38. HCC 37 is the chronic-complication bucket.
2. Expecting E11.65 to pay more than E11.9. Both are HCC 38. Both carry CNA 0.166.
3. Coding E11.65 from a lab only. A standalone A1C does not select E11.65.
4. Leaving E11.65 when a chronic-complication combination is supported. Use the combination (HCC 37). Hierarchy 37 over 38.
5. Inventing a V24 map. The live card shows V24 not mapped. Do not back-fill one.
Two-minute check
1. Confirm the provider assessed hyperglycemia this visit. Do not code from a lab only.
2. Assign E11.65 only when that assessment is in the note. Look that exact code up on HCC Buddy or in the encoder. Expect HCC 38, CNA 0.166.
3. Do not use E11.65 for ketoacidosis or hyperosmolarity. Those are HCC 36.
4. If the record supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). 37 supersedes 38.
5. Confirm MEAT this visit. Do not invent a V24 map.
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 a rewrite of the E11.22 leftover. Not an E11.52 leftover. Not an I70.209 leftover.
Sources
E11.65 (V28 HCC 38 CNA 0.166; live card shows no V24 mapping; no Code First; no Use Additional)
E11.9 (V28 HCC 38 CNA 0.166)
E11.22 (V28 HCC 37 CNA 0.166)
Related Tools
E11.65 card
V28 HCC 38, CNA 0.166. Confirm the live card. V24 is not mapped on that card.
E11.9 card
Type 2 DM without complications. Same V28 HCC 38, CNA 0.166.
E11.22 card
Type 2 DM with diabetic CKD. V28 HCC 37, CNA 0.166.
E11.22 desk
Chronic-complication leftover plus the N18 stage walk. This page is the 37-vs-38 leftover.
Diabetes HCC guide
E11.9 still maps to HCC 38. HCC 36, 37, and 38 share 0.166. This post is the E11.65 leftover.
Combination codes
Combination-code mechanics. This post is the E11.65 / HCC 38 leftover.
Encoder
Look up the exact E11.65, E11.9, or E11.22 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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