E08.01
BillableDiabetes mellitus due to underlying condition with hyperosmolarity with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E08.01 an HCC code?
Yes. E08.01 maps to Diabetes with Severe Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute Complications under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E08.01
For E08.01to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E08.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E08.01 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with hyperosmolarity with coma. High blood sugar caused by an underlying medical condition with dangerously concentrated blood that has progressed to a life-threatening coma. E08.01 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
Under the CMS-HCC V28 risk adjustment model, E08.01 maps to Diabetes with Severe Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E08.01 maps to Diabetes with Acute Complications (HCC 17) with a community, non-dual, aged base RAF weight of 0.302. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the underlying condition separately and code it in addition to this code. Because E08.01 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E08.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the underlying condition separately and code it in addition to this code
- •Ensure coma status is clearly documented in the medical record to justify this more severe code
Clinical Significance
Diabetes mellitus due to an underlying condition with hyperosmolarity with coma represents the most severe form of hyperosmolar hyperglycemic state in secondary diabetes, where extreme dehydration and hyperosmolarity have progressed to loss of consciousness. This is a medical emergency with mortality rates exceeding 20%, particularly in elderly patients. The comatose state reflects severe cerebral dehydration and requires immediate ICU-level care with careful fluid resuscitation and insulin therapy.
Documentation Requirements
- ✓Document the underlying causative condition, coma or severely altered consciousness, serum osmolality (typically >320 mOsm/kg), extreme hyperglycemia (often >600 mg/dL), and the causal chain from underlying condition to diabetes to hyperosmolar coma.
- ✓Record ICU admission, fluid resuscitation volumes, insulin protocol, and neurological monitoring.
Commonly Confused Codes
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