E08.42
BillableDiabetes mellitus due to underlying condition with diabetic polyneuropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E08.42 an HCC code?
Yes. E08.42 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic 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 E08.42
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.
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 0.245. 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.
Commonly Confused Codes
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