What is ICD-10 code E09.49?

E09.49 is the ICD-10-CM diagnosis code for Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication. Diabetes caused by medications or chemicals with nerve damage complications not specified in other categories. E09.49 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E09.49 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. E09.49 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. E09.49 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.

What is the V28 vs V24 difference for E09.49?

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. E09.49 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 should coders know when reporting E09.49?

Use this code only when the neurological complication doesn't fit E09.41-E09.44 Document the specific neurological complication in detail to support medical necessity Because E09.49 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.

2026 ICD-10-CM E09.49: Drug or chemical induced

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupE09.49Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

E09.49

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

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

Diabetes caused by medications or chemicals with nerve damage complications not specified in other categories.

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

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

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for E09.49 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E09.49 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

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

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

Includes

Official

ICD-10-CM does not list Includes notes for E09.49 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E09.49 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E09.49 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E09.49 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E09.49 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

The causative drug or chemical must be documented.

The specific neurological complication must be clearly described and differentiated from the standard neuropathy categories (E09.40-E09.44).

Supporting diagnostic studies and neurological examination findings should be included.

The causal relationship to drug-induced diabetes must be established.

MEAT Support

HCC Buddy guidance

The causative drug or chemical must be documented.

The specific neurological complication must be clearly described and differentiated from the standard neuropathy categories (E09.40-E09.44).

Supporting diagnostic studies and neurological examination findings should be included.

The causal relationship to drug-induced diabetes must be established.

Audit Caution

HCC Buddy guidance

This residual code should only be used after confirming the neurological condition does not fit codes E09.40-E09.

Provider query is recommended to determine if a more specific code applies. Document the specific neurological finding thoroughly to withstand audit scrutiny on a residual category code.

Common Mistakes

HCC Buddy guidance

E09.40-E09.44 are more specific neurological complication codes that should be used when applicable.

E09.69 (other specified complication) may be confused when the complication has overlapping features.

G99.0 (autonomic neuropathy in diseases classified elsewhere) should not replace this combination code.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is E09.49 an HCC code?

Yes. E09.49 maps to Diabetes with Chronic Complications under the V24 model but is not retained in V28.

Code: E09.49
Description: Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication
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 E09.49 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E09.49

For E09.49to 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 E09.49 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

E09.49 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication. Diabetes caused by medications or chemicals with nerve damage complications not specified in other categories. E09.49 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, E09.49 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.

Use this code only when the neurological complication doesn't fit E09.41-E09.44. Because E09.49 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 E09.49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when the neurological complication doesn't fit E09.41-E09.44
•Document the specific neurological complication in detail to support medical necessity

Clinical Significance

Drug or chemical induced diabetes mellitus with other diabetic neurological complication captures neurological manifestations that do not fit the standard categories of mononeuropathy, polyneuropathy, autonomic neuropathy, or amyotrophy. This may include conditions such as diabetic encephalopathy, central neuropathic pain syndromes, or cranial neuropathies not classified as mononeuropathy. These atypical neurological complications require specialized neurological evaluation.

Documentation Requirements

✓The causative drug or chemical must be documented.
✓The specific neurological complication must be clearly described and differentiated from the standard neuropathy categories (E09.40-E09.44).
✓Supporting diagnostic studies and neurological examination findings should be included.
✓The causal relationship to drug-induced diabetes must be established.

Commonly Confused Codes

•E09.40-E09.44 are more specific neurological complication codes that should be used when applicable.
•E09.69 (other specified complication) may be confused when the complication has overlapping features.
•G99.0 (autonomic neuropathy in diseases classified elsewhere) should not replace this combination code.