E08.42 ICD-10-CM Code: Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E08.42 maps to CMS-HCC V28 37 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E08.42
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDiabetes mellitus due to underlying condition with diabetic polyneuropathy
This code describes nerve damage affecting multiple nerves in the body caused by diabetes that developed as a result of another medical condition (such as pancreatitis or cystic fibrosis). The nerve damage typically causes weakness, numbness, or pain, usually starting in the feet and hands.
Buddy Insight
Diabetes mellitus due to an underlying condition with diabetic polyneuropathy is the most common form of diabetic neuropathy, presenting as symmetric, length-dependent sensorimotor neuropathy affecting the distal lower extremities first (stocking-glove distribution).
CMS-HCC V28
MappedHCC 37
RAF 0.166
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
MappedHCC 20
Varies by metal level
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
Official- Diabetes mellitus due to underlying condition with diabetic neuralgia
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E08.42 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E08.42 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E08.42 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E08.42 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E08.42 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E08.42 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E08.42 an HCC code?
Yes. E08.42 (Diabetes mellitus due to underlying condition with diabetic polyneuropathy) maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E08.42 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E08.42
- Description
- Diabetes mellitus due to underlying condition with diabetic polyneuropathy
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications
- RAF
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 E08.42 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E08.42
For E08.42 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 E08.42 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E08.42 is the ICD-10-CM diagnosis code for diabetes mellitus due to underlying condition with diabetic polyneuropathy. This code describes nerve damage affecting multiple nerves in the body caused by diabetes that developed as a result of another medical condition (such as pancreatitis or cystic fibrosis). The nerve damage typically causes weakness, numbness, or pain, usually starting in the feet and hands. E08.42 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, E08.42 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.166. Under the older V24 model, E08.42 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.
Always code the underlying condition first (e.g., pancreatitis, hemochromatosis) before assigning E08.42, as E08 diabetes requires documentation of the secondary cause. Because E08.42 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 E08.42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always code the underlying condition first (e.g., pancreatitis, hemochromatosis) before assigning E08.42, as E08 diabetes requires documentation of the secondary cause
- •Verify documentation specifies 'polyneuropathy' (multiple nerves affected) rather than mononeuropathy or other neuropathy types, as different 5th characters apply (e.g., E08.41 for mononeuropathy)
Clinical Significance
Diabetes mellitus due to an underlying condition with diabetic polyneuropathy is the most common form of diabetic neuropathy, presenting as symmetric, length-dependent sensorimotor neuropathy affecting the distal lower extremities first (stocking-glove distribution). This condition is a primary risk factor for diabetic foot ulceration, Charcot neuroarthropathy, and lower extremity amputation. In secondary diabetes, the combination of the underlying disease process and hyperglycemia-induced nerve damage may accelerate neuropathy progression.
Documentation Requirements
- ✓Document the underlying condition causing diabetes, the symmetric distal distribution of neuropathy, sensory examination findings (vibration, monofilament, temperature), motor examination findings, nerve conduction study results, and the current foot risk assessment.
- ✓Record pain management, foot care education, and protective footwear recommendations.