E09.00
BillableDrug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E09.00 an HCC code?
Yes. E09.00 maps to Diabetes with Acute Complications under the V24 model but is not retained in V28.
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 E09.00
For E09.00 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 E09.00 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E09.00 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (nkhhc). This code describes diabetes that develops as a side effect of certain medications or chemical exposure, with very high blood sugar levels and concentrated blood (hyperosmolarity), but without the serious complication of a hyperglycemic crisis. The patient's blood is too concentrated due to high glucose, but they have not developed the life-threatening condition called nonketotic hyperglycemic-hyperosmolar coma. E09.00 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 older CMS-HCC V24 model, E09.00 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.
Always identify and document the specific drug or chemical causing the diabetes, as this is required for accurate coding of drug-induced diabetes. Because E09.00 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 E09.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always identify and document the specific drug or chemical causing the diabetes, as this is required for accurate coding of drug-induced diabetes
- •Verify that the patient does NOT have NKHHC (nonketotic hyperglycemic-hyperosmolar coma); if they do, use code E09.01 instead
Clinical Significance
Drug or chemical induced diabetes mellitus with hyperosmolarity without coma represents a serious metabolic derangement where medications or toxic exposures have caused diabetes, and the patient has developed dangerously concentrated blood from extreme hyperglycemia. Hyperosmolarity indicates severe dehydration and glucose levels typically exceeding 600 mg/dL. Though the patient has not progressed to coma, this condition requires urgent inpatient management with aggressive fluid resuscitation and insulin therapy.
Documentation Requirements
- ✓The causative drug or chemical must be identified and documented with an additional external cause code from the Table of Drugs and Chemicals.
- ✓Serum osmolality, blood glucose levels, and mental status should be recorded.
- ✓Documentation must explicitly confirm the absence of nonketotic hyperglycemic-hyperosmolar coma to justify the 'without coma' distinction.