E09.649
BillableDrug or chemical induced diabetes mellitus with hypoglycemia without coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E09.649 an HCC code?
Yes. E09.649 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 E09.649
For E09.649 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 E09.649 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E09.649 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with hypoglycemia without coma. Dangerously low blood sugar caused by medication or chemical-induced diabetes without loss of consciousness. E09.649 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, E09.649 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 symptoms of hypoglycemia (tremors, sweating, confusion) and treatment provided. Because E09.649 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 E09.649 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document symptoms of hypoglycemia (tremors, sweating, confusion) and treatment provided
- •Distinguish from E09.641 by confirming the patient did not lose consciousness
Clinical Significance
Drug or chemical induced diabetes mellitus with hypoglycemia without coma represents episodes of dangerously low blood sugar in patients with drug-induced diabetes that do not progress to loss of consciousness. Recurrent hypoglycemia is a significant barrier to optimal glycemic management and carries risks including cognitive impairment, falls, cardiac arrhythmias, and development of hypoglycemia unawareness. Each episode necessitates medication adjustment and patient education.
Documentation Requirements
- ✓The causative drug or chemical must be identified.
- ✓Blood glucose levels during hypoglycemic episodes should be documented.
- ✓Symptoms experienced (tremor, sweating, confusion, palpitations) and self-treatment measures must be recorded.
- ✓The frequency of hypoglycemic episodes and any pattern (time of day, relation to meals/medications) should be noted.
- ✓Documentation must confirm the patient did not lose consciousness.
Commonly Confused Codes
- •E09.641 (with coma) is used when consciousness is lost.
- •E09.65 (hyperglycemia) represents the opposite blood sugar abnormality.
- •E16.0 (drug-induced hypoglycemia without coma) applies when hypoglycemia occurs without established diabetes.
- •E09.9 (without complications) should not be used when hypoglycemia is documented.