E08.11
BillableDiabetes mellitus due to underlying condition with ketoacidosis with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E08.11 an HCC code?
Yes. E08.11 maps to Diabetes with 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 E08.11
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.
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 Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.390. Under the older V24 model, E08.11 mapped to the same category but with a base RAF weight of 0.302 — V28 recalibrated weights across the entire model. 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
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