E09.11 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with ketoacidosis with coma

Code

E09.11

Description

Drug or chemical induced diabetes mellitus with ketoacidosis with coma

HCC (V28)

No CMS-HCC V28 mapping

RAF reference coefficient

—

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E09.11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E09.11

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E09.11 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 that caused the diabetes, as this is required for accurate coding of drug or chemical-induced diabetes
• •Verify that ketoacidosis with coma is present before assigning this code; if only ketoacidosis without coma exists, use E09.10 instead

Clinical Significance

Drug or chemical induced diabetes mellitus with ketoacidosis with coma is the most severe presentation of ketoacidosis in drug-induced diabetes, where metabolic acidosis has progressed to loss of consciousness. This is a critical medical emergency with significant mortality risk requiring immediate intensive care unit admission. The combination of severe acidosis, dehydration, electrolyte imbalance, and neurological compromise demands coordinated multidisciplinary management.

Documentation Requirements

• ✓The causative drug or chemical must be documented with appropriate external cause codes.
• ✓The coma state must be explicitly documented by the provider with level of consciousness assessment.
• ✓Comprehensive laboratory data including blood gas analysis, ketone levels, glucose, electrolytes, and renal function must be recorded.
• ✓The temporal relationship between drug exposure and the diabetic emergency must be established.

Commonly Confused Codes

• •E09.10 (ketoacidosis without coma) applies when the patient remains conscious.
• •E09.01 (hyperosmolarity with coma) involves a different metabolic mechanism.
• •E10.11 (Type 1 with ketoacidosis with coma) must not be used for drug-induced diabetes.
• •E09.641 (hypoglycemia with coma) involves low rather than high blood sugar.

Child Codes