E09.641
BillableDrug or chemical induced diabetes mellitus with hypoglycemia with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E09.641 an HCC code?
Yes. E09.641 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 E09.641
For E09.641 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 E09.641 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E09.641 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with hypoglycemia with coma. Dangerously low blood sugar caused by medication or chemical-induced diabetes that is severe enough to cause loss of consciousness. E09.641 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, E09.641 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 a medical emergency; document the severity and whether the patient lost consciousness. Because E09.641 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 E09.641 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a medical emergency; document the severity and whether the patient lost consciousness
- •Identify the causative medication or chemical and note any contributing factors to the hypoglycemic episode
Clinical Significance
Drug or chemical induced diabetes mellitus with hypoglycemia with coma is a medical emergency representing dangerously low blood sugar severe enough to cause loss of consciousness. In drug-induced diabetes, hypoglycemia may result from the interaction between diabetes medications and the causative agent, or from hepatic/renal impairment affecting drug metabolism. Hypoglycemic coma requires immediate glucose administration and carries risk of permanent neurological damage if treatment is delayed.
Documentation Requirements
- ✓The causative drug or chemical for the diabetes must be documented.
- ✓Blood glucose level at the time of the event must be recorded.
- ✓The coma or loss of consciousness must be explicitly documented with duration and level of consciousness assessment.
- ✓Treatment provided (IV dextrose, glucagon) and response should be noted.
- ✓Contributing factors such as missed meals, medication errors, or renal insufficiency must be identified.
Commonly Confused Codes
- •E09.649 (hypoglycemia without coma) is used when the patient remains conscious.
- •E09.01 (hyperosmolarity with coma) and E09.11 (ketoacidosis with coma) involve high blood sugar rather than low.
- •E16.0 (drug-induced hypoglycemia without coma) applies to hypoglycemia not in the context of established diabetes.