E10.628
BillableType 1 diabetes mellitus with other skin complications
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.628 an HCC code?
Yes. E10.628 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic 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 E10.628
For E10.628 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 E10.628 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.628 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with other skin complications. Type 1 diabetes with other skin problems caused by diabetes, such as infections, thickening of skin, or other diabetic skin manifestations. E10.628 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, E10.628 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E10.628 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.
Use this code for diabetic skin complications not captured by dermatitis or ulcer codes. Because E10.628 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 E10.628 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for diabetic skin complications not captured by dermatitis or ulcer codes
- •Clearly document the specific skin condition and its relationship to diabetes
Clinical Significance
Type 1 diabetes mellitus with other skin complications covers a range of diabetes-related skin conditions beyond dermatitis and ulceration, including necrobiosis lipoidica, diabetic bullae, scleroderma diabeticorum, acanthosis nigricans, and xanthoma diabeticorum. These conditions reflect systemic metabolic and microvascular effects of chronic hyperglycemia on the integumentary system and may serve as clinical markers of disease severity.
Documentation Requirements
- ✓The provider must document the specific skin complication and its relationship to Type 1 diabetes.
- ✓The record should describe the appearance, location, and extent of the skin condition, along with any biopsy results or dermatological assessment.
- ✓Documentation must confirm the condition does not fit dermatitis (E10.620) or ulceration categories (E10.621/E10.622).