E10.52 ICD-10-CM Code: Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.52 maps to CMS-HCC V28 37 (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)
E10.52
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 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.
Buddy Insight
Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene represents one of the most severe macrovascular complications of diabetes.
CMS-HCC V28
MappedHCC 37
RAF 0.166
+ HCC 263
CMS-HCC V24
MappedHCC 18
RAF 0.302
+ HCC 106
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 18
RAF 0.084
+ HCC 106
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
Official- Type 1 diabetes mellitus with diabetic gangrene
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E10.52 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E10.52 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E10.52 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E10.52 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E10.52 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E10.52 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 E10.52 an HCC code?
Yes. E10.52 (Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene) maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E10.52 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E10.52
- Description
- Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
- HCC (V28)
- HCC 37 — Diabetes with Chronic 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 E10.52 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
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.
Coder workflow notes
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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).
Under the CMS-HCC V28 risk adjustment model, E10.52 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.166. Under the older V24 model, E10.52 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.
Gangrene is a serious complication requiring clear documentation of affected body part and extent of tissue necrosis. Because E10.52 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 E10.52 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.