E10.51
BillableType 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.51 an HCC code?
Yes. E10.51 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model.
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 E10.51
For E10.51 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 E10.51 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.51 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene. Type 1 diabetes with blood vessel damage in the legs and feet that restricts blood flow, but without tissue death or gangrene. E10.51 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, E10.51 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. E10.51 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
Distinguish between E10.51 (without gangrene) and E10.52 (with gangrene) based on presence or absence of necrotic tissue. Because E10.51 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 E10.51 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between E10.51 (without gangrene) and E10.52 (with gangrene) based on presence or absence of necrotic tissue
- •Document the location and severity of peripheral angiopathy to support the diagnosis
Clinical Significance
Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene indicates significant macrovascular disease where chronically elevated blood glucose has damaged the peripheral arterial system. This leads to reduced blood flow to the extremities, causing claudication, poor wound healing, and increased infection risk. Early identification and management can prevent progression to gangrene and potential amputation.
Documentation Requirements
- ✓Documentation must specify peripheral angiopathy or peripheral arterial disease as a complication of Type 1 diabetes, and must explicitly state that gangrene is absent.
- ✓Include vascular assessment findings such as ankle-brachial index results, pulse examination, or imaging studies.
- ✓The location and severity of vascular compromise should be recorded along with any treatment plan.