E09.65
BillableDrug or chemical induced diabetes mellitus with hyperglycemia
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E09.65 an HCC code?
Yes. E09.65 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 E09.65
For E09.65to 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 E09.65 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E09.65 is the ICD-10-CM diagnosis code for drug or chemical induced diabetes mellitus with hyperglycemia. Abnormally high blood sugar levels in patients with diabetes caused by medications or chemicals. E09.65 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, E09.65 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 the blood glucose level and whether this represents acute hyperglycemia or chronic poor control. Because E09.65 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 E09.65 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the blood glucose level and whether this represents acute hyperglycemia or chronic poor control
- •Note any precipitating factors such as infection, stress, or medication non-compliance
Clinical Significance
Drug or chemical induced diabetes mellitus with hyperglycemia indicates inadequately controlled blood sugar levels in patients with drug-induced diabetes. Persistent hyperglycemia accelerates microvascular and macrovascular complications including retinopathy, nephropathy, neuropathy, and cardiovascular disease. In drug-induced diabetes, the causative medication may need dose adjustment or discontinuation if hyperglycemia cannot be managed with standard diabetes therapies.
Documentation Requirements
- ✓The causative drug or chemical must be documented.
- ✓Blood glucose levels or hemoglobin A1c values demonstrating hyperglycemia should be recorded.
- ✓The provider should document whether hyperglycemia is acute (new onset or stress-related) or represents chronic poor control.
- ✓Current diabetes management regimen and any medication adjustments should be noted.
Commonly Confused Codes
- •E09.9 (without complications) should be used when diabetes is well-controlled without hyperglycemia.
- •E09.00 (hyperosmolarity without coma) represents a more severe hyperglycemic state.
- •E09.649 (hypoglycemia) is the opposite blood sugar abnormality.
- •R73.9 (hyperglycemia, unspecified) should not be used instead of this combination code in patients with established diabetes.