What is ICD-10 code E09.43?

E09.43 is the ICD-10-CM diagnosis code for Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy. Diabetes caused by medications or chemicals that damages nerves controlling automatic body functions like heart rate, digestion, and blood pressure. E09.43 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E09.43 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E09.43 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E09.43 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E09.43 map to under V28?

E09.43 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does E09.43 pay in RAF?

E09.43 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for E09.43?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. E09.43 was a payment HCC under V24 (Diabetes with Chronic Complications) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports E09.43?

Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction This code indicates involvement of the autonomic nervous system, not just sensory/motor nerves Because E09.43 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM E09.43: Drug or chemical induced

E09.43 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupE09.43Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E09.43

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy

Diabetes caused by medications or chemicals that damages nerves controlling automatic body functions like heart rate, digestion, and blood pressure.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.302

ACA/HHS

Mapped

HCC 20

HHS-HCC 20

Varies by metal level

ESRD/PACE

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.084

RXHCC

Mapped

HCC 30

Diabetes with Complications

RAF 0.495

Code Book Path

Official

E09Drug or chemical induced diabetes mellitus

E09.4Drug or chemical induced diabetes mellitus with neurological complications

E09.43Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy

Inclusion Terms

Official

Drug or chemical induced diabetes mellitus with diabetic gastroparesis

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E09.43 in this effective period.

Related Child Codes

Official

E09.40Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified

E09.41Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy

E09.42Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy

E09.44Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy

E09.49Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication

Includes

Official

ICD-10-CM does not list Includes notes for E09.43 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E09.43 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E09.43 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E09.43 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E09.43 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

The causative drug or chemical must be identified.

Specific autonomic symptoms must be documented, such as gastroparesis, orthostatic hypotension, resting tachycardia, neurogenic bladder, or erectile dysfunction.

Diagnostic testing results (tilt-table test, gastric emptying study, heart rate variability) should be referenced.

The causal link between drug-induced diabetes and autonomic dysfunction must be established.

MEAT Support

HCC Buddy guidance

The causative drug or chemical must be identified.

Specific autonomic symptoms must be documented, such as gastroparesis, orthostatic hypotension, resting tachycardia, neurogenic bladder, or erectile dysfunction.

Diagnostic testing results (tilt-table test, gastric emptying study, heart rate variability) should be referenced.

The causal link between drug-induced diabetes and autonomic dysfunction must be established.

Audit Caution

HCC Buddy guidance

Autonomic neuropathy is often underdiagnosed because symptoms may be attributed to other conditions (e.g., gastroparesis coded alone without linking to diabetes).

Multiple autonomic symptoms may coexist, but a single combination code captures the complication.

Ensure the diagnosis is supported by objective testing when possible.

Common Mistakes

HCC Buddy guidance

E09.42 (polyneuropathy) involves sensory/motor nerves rather than autonomic nerves, though both may coexist.

E09.40 (unspecified neuropathy) is too vague when autonomic involvement is documented.

K31.84 (gastroparesis) may be coded additionally but does not replace the diabetes combination code.

I95.1 (orthostatic hypotension) may be a manifestation.

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 E09.43 an HCC code?

Yes. E09.43 maps to Diabetes with Chronic Complications under the V24 model but is not retained in V28.

Code: E09.43
Description: Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 18, Diabetes with Chronic Complications

0.302

ESRDHCC 18, Diabetes with Chronic Complications

0.084

RxHCCHCC 30, Diabetes with Complications

0.495

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 E09.43 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E09.43

For E09.43 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 E09.43 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E09.43 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy. Diabetes caused by medications or chemicals that damages nerves controlling automatic body functions like heart rate, digestion, and blood pressure. E09.43 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, E09.43 maps to Diabetes with Chronic Complications (HCC 18) 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.

Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction. Because E09.43 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 E09.43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction
•This code indicates involvement of the autonomic nervous system, not just sensory/motor nerves

Clinical Significance

Drug or chemical induced diabetes mellitus with diabetic autonomic neuropathy affects the nerves controlling involuntary body functions including heart rate, blood pressure, digestion, bladder function, and sweating. This is a particularly serious form of neuropathy because it can cause life-threatening cardiac arrhythmias, severe gastroparesis, orthostatic hypotension, and silent myocardial ischemia. Patients with autonomic neuropathy have significantly higher mortality rates than those with other forms of diabetic neuropathy.

Documentation Requirements

✓The causative drug or chemical must be identified.
✓Specific autonomic symptoms must be documented, such as gastroparesis, orthostatic hypotension, resting tachycardia, neurogenic bladder, or erectile dysfunction.
✓Diagnostic testing results (tilt-table test, gastric emptying study, heart rate variability) should be referenced.
✓The causal link between drug-induced diabetes and autonomic dysfunction must be established.

Commonly Confused Codes

•E09.42 (polyneuropathy) involves sensory/motor nerves rather than autonomic nerves, though both may coexist.
•E09.40 (unspecified neuropathy) is too vague when autonomic involvement is documented.
•K31.84 (gastroparesis) may be coded additionally but does not replace the diabetes combination code.
•I95.1 (orthostatic hypotension) may be a manifestation.