E10.11
BillableType 1 diabetes mellitus with ketoacidosis with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.11 an HCC code?
Yes. E10.11 maps to Diabetes with Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute Complications under V24).
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 E10.11
For E10.11 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 E10.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.11 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with ketoacidosis with coma. Type 1 diabetes with a life-threatening condition where the body produces too much acid in the blood, causing the patient to lose consciousness. E10.11 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, E10.11 maps to Diabetes with Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.390. Under the older V24 model, E10.11 mapped to the same category but with a base RAF weight of 0.302 — V28 recalibrated weights across the entire model. 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 critical emergency; document the level of consciousness and all interventions performed. Because E10.11 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 E10.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a critical emergency; document the level of consciousness and all interventions performed
- •Ensure documentation includes precipitating factors (infection, missed insulin doses, etc.)
Clinical Significance
Type 1 diabetes mellitus with ketoacidosis with coma represents the most severe manifestation of diabetic ketoacidosis, where metabolic acidosis has progressed to loss of consciousness. This is a life-threatening emergency with mortality rates of 0.5-5% in developed countries, rising significantly in elderly patients. Cerebral edema is a feared complication, particularly in pediatric patients. Immediate intensive care management with careful insulin titration, fluid resuscitation, and close neurological monitoring is mandatory.
Documentation Requirements
- ✓Documentation must confirm Type 1 diabetes and ketoacidosis with comprehensive laboratory values.
- ✓The coma or loss of consciousness must be explicitly documented by the provider with Glasgow Coma Scale score when available.
- ✓Precipitating factors, treatment timeline, and clinical response must be recorded.
- ✓Neurological assessments and any imaging performed should be documented.
Commonly Confused Codes
- •E10.10 (without coma) is used when the patient remains conscious.
- •E10.01 would represent hyperosmolarity with coma (not a valid Type 1 code in this context).
- •E09.11 (drug-induced with ketoacidosis with coma) applies only to drug-induced diabetes.
- •Metabolic encephalopathy from other causes should be differentiated.