What is ICD-10 code E08.11?

E08.11 is the ICD-10-CM diagnosis code for Diabetes mellitus due to underlying condition with ketoacidosis with coma. Dangerous acid buildup in the blood from diabetes caused by an underlying condition that has progressed to a life-threatening coma. E08.11 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E08.11 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E08.11 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E08.11 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E08.11 map to under V28?

E08.11 maps to CMS-HCC V28 36 (Diabetes with Severe Acute Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does E08.11 pay in RAF?

E08.11 carries a community, non-dual, aged (CNA) RAF weight of 0.166 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for E08.11?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For E08.11, V28 maps to Diabetes with Severe Acute Complications at RAF 0.166 while V24 mapped to Diabetes with Acute Complications at RAF 0.302. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM E08.11: Diabetes mellitus due

E08.11 maps to CMS-HCC V28 36 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupE08.11Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E08.11

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Diabetes mellitus due to underlying condition with ketoacidosis with coma

Dangerous acid buildup in the blood from diabetes caused by an underlying condition that has progressed to a life-threatening coma.

Buddy Insight

CMS-HCC V28

Mapped

HCC 36

Diabetes with Severe Acute Co...

RAF 0.166

CMS-HCC V24

Mapped

HCC 17

Diabetes with Acute Complicat...

RAF 0.302

ACA/HHS

Mapped

HCC 19

HHS-HCC 19

Varies by metal level

ESRD/PACE

Mapped

HCC 17

Diabetes with Acute Complicat...

RAF 0.084

RXHCC

Mapped

HCC 30

Diabetes with Complications

RAF 0.495

Code Book Path

Official

E08Diabetes mellitus due to underlying condition

E08.1Diabetes mellitus due to underlying condition with ketoacidosis

E08.11Diabetes mellitus due to underlying condition with ketoacidosis with coma

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E08.11 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E08.11 in this effective period.

Related Child Codes

Official

E08.10Diabetes mellitus due to underlying condition with ketoacidosis without coma

Includes

Official

ICD-10-CM does not list Includes notes for E08.11 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E08.11 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E08.11 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E08.11 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E08.11 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Document the underlying causative condition, coma or severe alteration in consciousness, complete diabetic ketoacidosis laboratory panel (pH, anion gap, bicarbonate, ketones, glucose), and the relationship between the underlying condition and diabetes.

Record ICU admission, insulin and fluid resuscitation protocols, electrolyte monitoring, and neurological assessments.

Assign the underlying condition code first.

MEAT Support

HCC Buddy guidance

Record ICU admission, insulin and fluid resuscitation protocols, electrolyte monitoring, and neurological assessments.

Assign the underlying condition code first.

Audit Caution

HCC Buddy guidance

Coma must be explicitly documented by the provider — altered mental status or confusion alone may not qualify.

Cerebral edema is a potential complication of diabetic ketoacidosis treatment, particularly in younger patients, and should be coded separately if it occurs.

Ensure the underlying condition is sequenced first.

Common Mistakes

HCC Buddy guidance

E08.10: Same condition WITHOUT coma — use when mental status is preserved during diabetic ketoacidosis

E08.01: Diabetes due to underlying condition with hyperosmolarity with coma — different metabolic mechanism

E10.11: Type 1 diabetes with ketoacidosis with coma — use for autoimmune type 1 diabetes

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E08.11 an HCC code?

Yes. E08.11 (Diabetes mellitus due to underlying condition with ketoacidosis with coma) maps to Diabetes with Severe Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.

Coder answer: E08.11 is billable and maps to V28 HCC 36, Diabetes with Severe Acute Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: E08.11
Description: Diabetes mellitus due to underlying condition with ketoacidosis with coma
HCC (V28): HCC 36 — Diabetes with Severe Acute Complications
RAF: 0.166
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 36, Diabetes with Severe Acute Complications

0.166

V24HCC 17, Diabetes with Acute Complications

0.302

ESRDHCC 17, Diabetes with Acute Complications

0.084

RxHCCHCC 30, Diabetes with Complications

0.495

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work E08.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E08.11

For E08.11 to 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 E08.11 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E08.11 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with ketoacidosis with coma. Dangerous acid buildup in the blood from diabetes caused by an underlying condition that has progressed to a life-threatening coma. E08.11 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, E08.11 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, E08.11 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.

This is a medical emergency; ensure coma status is explicitly documented. Because E08.11 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 E08.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a medical emergency; ensure coma status is explicitly documented
•Code the underlying condition separately along with this code

Clinical Significance

Diabetes mellitus due to an underlying condition with ketoacidosis with coma represents the most severe presentation of diabetic ketoacidosis in secondary diabetes, combining metabolic acidosis, ketonemia, and loss of consciousness. This is a critical care emergency with mortality risk significantly higher than diabetic ketoacidosis without coma. The combination of severe metabolic derangement and neurological compromise demands aggressive resuscitation and continuous monitoring.

Documentation Requirements

✓Document the underlying causative condition, coma or severe alteration in consciousness, complete diabetic ketoacidosis laboratory panel (pH, anion gap, bicarbonate, ketones, glucose), and the relationship between the underlying condition and diabetes.
✓Record ICU admission, insulin and fluid resuscitation protocols, electrolyte monitoring, and neurological assessments.
✓Assign the underlying condition code first.

Commonly Confused Codes

•E08.10: Same condition WITHOUT coma: use when mental status is preserved during diabetic ketoacidosis
•E08.01: Diabetes due to underlying condition with hyperosmolarity with coma: different metabolic mechanism
•E10.11: Type 1 diabetes with ketoacidosis with coma: use for autoimmune type 1 diabetes