E10.11 ICD-10-CM Code: Type 1 diabetes mellitus with ketoacidosis with coma
E10.11 maps to CMS-HCC V28 36. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E10.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 36
Coefficient HCC 36: 0.166 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 019, HCC 022
Coefficient needs member context
ESRD/PACE
Context neededHCC 17
Coefficient needs member context
RXHCC
MappedHCC 30
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for E10.11. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E10.11. Check the code and parent instructions in the Code Book.
Related Codes
Includes
Official- brittle diabetes (mellitus)Inherited from E10
- diabetes (mellitus) due to autoimmune processInherited from E10
- diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destructionInherited from E10
- idiopathic diabetes (mellitus)Inherited from E10
- juvenile onset diabetes (mellitus)Inherited from E10
- ketosis-prone diabetes (mellitus)Inherited from E10
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E10
- diabetes mellitus due to underlying condition (E08.-)Inherited from E00-E89, E10
- drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E10
- gestational diabetes (O24.4-)Inherited from E00-E89, E10
- hyperglycemia NOS (R73.9)Inherited from E00-E89, E10
- neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E10
- postpancreatectomy diabetes mellitus (E13.-)Inherited from E00-E89, E10
- postprocedural diabetes mellitus (E13.-)Inherited from E00-E89, E10
- secondary diabetes mellitus NEC (E13.-)Inherited from E00-E89, E10
- type 2 diabetes mellitus (E11.-)Inherited from E00-E89, E10
Code First
OfficialNo Code First sequencing instructions are included in this display for E10.11. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E10.11. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E10.11. Check the code and parent instructions in the Code Book.
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 E10.11 an HCC code?
Yes. E10.11 (Type 1 diabetes mellitus with ketoacidosis with coma) maps to HCC 36, Diabetes with Severe Acute Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.166. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: E10.11 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
- E10.11
- Description
- Type 1 diabetes mellitus with ketoacidosis with coma
- HCC (V28)
- HCC 36 — Diabetes with Severe Acute Complications
- RAF reference coefficient
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work E10.11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E10.11
For E10.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 Severe Acute Complications (HCC 36) with a source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E10.11; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a critical emergency; document the level of consciousness and all interventions performed. For E10.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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.