E09.630 ICD-10-CM Code: Drug or chemical induced diabetes mellitus with periodontal disease
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E09.630
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDrug or chemical induced diabetes mellitus with periodontal disease
This code describes diabetes that was caused by taking certain medications or exposure to chemicals, and the patient also has gum disease affecting the tissues that support the teeth. The diabetes and gum disease are both present as complications of the drug or chemical exposure.
Buddy Insight
Drug or chemical induced diabetes mellitus with periodontal disease represents the bidirectional relationship between diabetes and gum disease.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 18
RAF 0.0
RXHCC
MappedHCC 30
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E09.630 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E09.630 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E09.630 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E09.630 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E09.630 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E09.630 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E09.630 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E09.630 an HCC code?
Yes. E09.630 maps to Diabetes with Chronic 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 E09.630
For E09.630to 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 E09.630 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
E09.630 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with periodontal disease. This code describes diabetes that was caused by taking certain medications or exposure to chemicals, and the patient also has gum disease affecting the tissues that support the teeth. The diabetes and gum disease are both present as complications of the drug or chemical exposure. E09.630 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, E09.630 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.
Always identify and document the specific drug or chemical that caused the diabetes, as this information is essential for accurate coding and patient safety. Because E09.630 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 E09.630 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 information is essential for accurate coding and patient safety
- •Ensure that periodontal disease is documented in the medical record; if only diabetes is present without confirmed gum disease, use the appropriate diabetes code without the periodontal disease component
Clinical Significance
Drug or chemical induced diabetes mellitus with periodontal disease represents the bidirectional relationship between diabetes and gum disease. Diabetic patients have a 2-3 times higher risk of periodontal disease due to impaired immune response, altered collagen metabolism, and microvascular changes in gingival tissues. Conversely, periodontal infection can worsen glycemic control through systemic inflammation, creating a cycle that accelerates both conditions.
Documentation Requirements
- ✓The causative drug or chemical must be documented.
- ✓Dental or periodontal examination findings must confirm the presence of periodontal disease with clinical parameters such as probing depths, attachment loss, and radiographic bone loss.
- ✓The link between the drug-induced diabetes and periodontal disease must be established.
- ✓Type and severity of periodontal disease should be specified.
Commonly Confused Codes
- •E09.638 (other oral complications) is used for oral conditions that are not periodontal disease.
- •K05.x (gingivitis and periodontal diseases) may be coded additionally but should not replace this combination code.
- •E09.620 (dermatitis) involves skin rather than oral tissues.
- •E11.630 (Type 2 with periodontal disease) is incorrect for drug-induced diabetes.