E10.10 ICD-10-CM Code: Type 1 diabetes mellitus with ketoacidosis without coma
E10.10 maps to CMS-HCC V28 36 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E10.10
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 1 diabetes mellitus with ketoacidosis without coma
Type 1 diabetes with a serious condition where the body produces too much acid in the blood, but the patient remains conscious.
Buddy Insight
Type 1 diabetes mellitus with ketoacidosis without coma is a serious acute metabolic emergency common in patients with insulin-dependent diabetes.
CMS-HCC V28
MappedHCC 36
RAF 0.166
CMS-HCC V24
MappedHCC 17
RAF 0.302
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 17
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E10.10 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E10.10 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E10.10 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E10.10 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E10.10 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E10.10 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E10.10 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E10.10 an HCC code?
Yes. E10.10 (Type 1 diabetes mellitus with ketoacidosis without coma) maps to Diabetes with Severe Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E10.10 is billable and maps to V28 HCC 36, Diabetes with Severe Acute Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E10.10
- Description
- Type 1 diabetes mellitus with ketoacidosis without coma
- HCC (V28)
- HCC 36 — Diabetes with Severe Acute Complications
- RAF
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 E10.10 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E10.10
For E10.10 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 E10.10 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E10.10 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with ketoacidosis without coma. Type 1 diabetes with a serious condition where the body produces too much acid in the blood, but the patient remains conscious. E10.10 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 CMS-HCC V28 risk adjustment model, E10.10 maps to Diabetes with Severe Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E10.10 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.
Ketoacidosis is a medical emergency; document arterial blood gas results and pH levels. Because E10.10 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 E10.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ketoacidosis is a medical emergency; document arterial blood gas results and pH levels
- •Distinguish from E10.11 by confirming the patient did not lose consciousness
Clinical Significance
Type 1 diabetes mellitus with ketoacidosis without coma is a serious acute metabolic emergency common in patients with insulin-dependent diabetes. Diabetic ketoacidosis occurs when absolute insulin deficiency leads to uncontrolled lipolysis, generating ketone bodies that acidify the blood. This condition is the leading cause of death in children with Type 1 diabetes and requires aggressive management with insulin infusion, fluid resuscitation, and electrolyte correction. The patient remains conscious, distinguishing this from the more severe E10.11.
Documentation Requirements
- ✓Documentation must confirm the Type 1 diabetes diagnosis and the presence of ketoacidosis with supporting laboratory values including arterial blood gas, serum ketones, glucose, electrolyte panel, and anion gap.
- ✓Precipitating factors (infection, insulin omission, pump failure, new diagnosis) should be identified.
- ✓The patient's mental status must confirm the absence of coma.
Commonly Confused Codes
- •E10.11 (with coma) is used when consciousness is lost. E10.65 (with hyperglycemia) is for elevated blood sugar without the acidosis component. E13.10 (other specified diabetes with ketoacidosis) is incorrect for Type
- •E09.10 (drug-induced diabetes with ketoacidosis) applies only when diabetes is medication-induced. E11.65 should not be used as Type 2 diabetes rarely presents with ketoacidosis.