E10.52
BillableType 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.52 an HCC code?
No. E10.52 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 E10.52
For E10.52 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 E10.52 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.52 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene. Type 1 diabetes with blood vessel damage in the legs and feet that has progressed to tissue death (gangrene), potentially requiring amputation. E10.52 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
E10.52 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to an HCC in V28 or V24, which is a notable gap given the clinical severity. Coders should ensure all related conditions (such as amputation status, chronic kidney disease, or vascular disease codes) are captured separately to maximize appropriate risk adjustment for this high-acuity patient population.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E10.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Gangrene is a serious complication requiring clear documentation of affected body part and extent of tissue necrosis
- •Coordinate coding with any amputation codes if tissue removal is performed
Clinical Significance
Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene represents one of the most severe macrovascular complications of diabetes. Gangrene indicates tissue death from inadequate blood supply and often necessitates surgical debridement or amputation. This condition reflects end-stage peripheral vascular disease in a diabetic patient and carries high morbidity, mortality, and healthcare resource utilization.
Documentation Requirements
- ✓Documentation must clearly state gangrene is present in the context of diabetic peripheral angiopathy in a Type 1 diabetic patient.
- ✓Record the specific anatomical location, extent of necrotic tissue, whether it is dry or wet gangrene, and any associated infection.
- ✓Surgical consultation notes, vascular imaging, and wound care documentation should support the diagnosis.
Commonly Confused Codes
- •E10.51 (without gangrene) is used when peripheral vascular disease is present but no tissue death has occurred.
- •I96 (gangrene, not elsewhere classified) should not be used instead of this combination code when diabetes is the underlying cause.
- •L97 series (non-pressure chronic ulcer) may be used as additional codes for ulcer specificity but do not replace the diabetic combination code.