E11.9 Maps to HCC 38 in V28, Not HCC 37

E11.9 maps to HCC 38. It does not map to HCC 37. Public FAQ pages still pair type 2 DM without complications with HCC 37. That pairing is the miss.

Open the live E11.9, E11.65, and E11.22 cards before you invent a 37 row on the no-complication code. This page is the desk table for that leftover. It is not a rewrite of the E11.65 desk. That leftover is hyperglycemia. This leftover is E11.9.

*Current as of August 28, 2026. V28 mapping and CNA factors come from the live code pages named below and the 2026 Final ICD-10-CM Mappings. Non-PACE Medicare Advantage uses 100% V28 for payment year 2026. PACE follows a separate transition. Look the exact codes up. Do not code from this recap.*

Quick answer

No. E11.9 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.

E11.9 and E11.65 sit in the same bucket. HCC 37 is chronic complications. HCC 38 is no, glycemic, or unspecified. Hierarchy is 37 over 38.

Same bucket as E11.65. Hierarchy is 37 over 38.

The live HCC 38 card lists 17 ICD-10-CM codes. E11.9 and E11.65 are two of them. Reporting both still pays 38 once.

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.

If the chart also supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). Hierarchy keeps one diabetes HCC. 37 supersedes 38.

The E11.65 desk is the hyperglycemia leftover. The E11.22 desk is the chronic-complication plus N18 walk. This page is the E11.9 leftover.

Historical V24 mapping

E11.9 maps to HCC 19 in the CMS-HCC V24 column of the CMS 2025 Midyear/Final ICD-10-CM Mappings. This is a historical PY2025 reference. E11.9 maps to V24 HCC 19; E11.65 maps to V24 HCC 18. Both map to V28 HCC 38 for PY2026. The CMS 2026 Rate Announcement completes the V28 phase-in for non-PACE Medicare Advantage; PACE follows a separate transition.

What E11.9 needs

The provider must assess type 2 diabetes this encounter. Absence of complications should be implicit or stated. A problem-list row is not enough.

Do not default to E11.9 when the note supports hyperglycemia (E11.65, still HCC 38), a chronic-complication combination (HCC 37), or ketoacidosis (E11.10 / E11.11) or hyperosmolarity (E11.00 / E11.01). Those last four map to HCC 36.

E11.A is type 2 DM without complications in remission. It is Excludes 1 with E11.9. Look the live card up. E11.A is not in the PY2026 V28 map file. Do not invent an HCC.

The live E11.9 card lists Use Additional codes for long-term insulin and antidiabetic drugs. Look those exact cards up. Do not invent a second diabetes HCC from a Z code.

Review documentation support

An HCC mapping does not establish reportability. Review the full eligible record and apply the official coding, encounter, program and payer requirements. 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 E11.9 as HCC 37. Public FAQ pages still say 37. The live card and the PY2026 V28 map file say 38.

2. Expecting E11.9 to pay differently than E11.65. Both are HCC 38. Both carry CNA 0.166.

3. Leaving E11.9 when a chronic-complication combination is supported. Use the combination (HCC 37). Hierarchy 37 over 38.

4. Mistaking a missing card value for no historical mapping. E11.9 maps to CMS-HCC V24 HCC 19 in the historical PY2025 file. Check the model and payment year.

5. Assigning E11.9 when the record supports remission (E11.A). Those are Excludes 1. Look the E11.A card up.

Two-minute check

1. Confirm the provider assessed type 2 diabetes this visit, without a supported complication.

2. Assign E11.9 only when that is what the note supports. Look that exact code up on HCC Buddy or in the encoder. Expect HCC 38, CNA 0.166.

3. If the record supports hyperglycemia, that is E11.65. Still HCC 38. Same 0.166.

4. If the record supports CKD, neuropathy, retinopathy, or peripheral angiopathy, use that combination (HCC 37). 37 supersedes 38.

5. Review documentation support under the applicable official rules. Keep historical PY2025 V24 references separate from PY2026 V28.

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 rewrite of the E11.65 leftover. Not the E11.22 leftover.

Sources

E11.9 (V28 HCC 38 CNA 0.166; historical PY2025 CMS-HCC V24 HCC 19; see the CMS 2025 mapping source above)

E11.65 (V28 HCC 38 CNA 0.166; historical PY2025 CMS-HCC V24 HCC 18; see the CMS 2025 mapping source above)

E11.22 (V28 HCC 37 CNA 0.166)

HCC 38 (17 codes; CNA 0.166; superseded by HCC 35, HCC 36, HCC 37)

HCC 37 · HCC 36

E11.65 desk

E11.22 desk

CMS 2026 Model Software / Final ICD-10-CM Mappings