E09.01
BillableDrug or chemical induced diabetes mellitus with hyperosmolarity with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E09.01 an HCC code?
Yes. E09.01 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 E09.01
For E09.01to 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 E09.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E09.01 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with hyperosmolarity with coma. Diabetes caused by medications or chemicals with a dangerous blood sugar condition (hyperosmolarity) severe enough to cause loss of consciousness. E09.01 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, E09.01 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 an acute, life-threatening condition requiring immediate documentation of the causative drug or chemical. Because E09.01 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 E09.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is an acute, life-threatening condition requiring immediate documentation of the causative drug or chemical
- •Identify and code the specific medication or chemical agent responsible for inducing the diabetes
Clinical Significance
Drug or chemical induced diabetes mellitus with hyperosmolarity with coma is a life-threatening emergency where medication or chemical exposure has caused diabetes complicated by extreme blood concentration and loss of consciousness. This represents the most severe form of hyperosmolar hyperglycemic state in drug-induced diabetes, with mortality rates of 10-20%. Immediate intensive care admission with aggressive fluid replacement, insulin infusion, and correction of electrolyte imbalances is required.
Documentation Requirements
- ✓Documentation must identify the specific causative drug or chemical with external cause coding.
- ✓The coma or altered consciousness must be explicitly documented with Glasgow Coma Scale score if available.
- ✓Serum osmolality, glucose levels, electrolytes, and renal function should be recorded.
- ✓The temporal relationship between the drug exposure and the diabetic emergency must be established.