What is ICD-10 code E10.630?

E10.630 is the ICD-10-CM diagnosis code for Type 1 diabetes mellitus with periodontal disease. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E10.630 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E10.630 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E10.630 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E10.630 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E10.630 map to under V28?

E10.630 maps to CMS-HCC V28 HCC 37 (Diabetes with Chronic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports E10.630?

Verify that the medical record explicitly documents both Type 1 diabetes and periodontal disease; do not assume the connection without clear clinical documentation Ensure the periodontal disease is documented as a complication of the diabetes rather than a separate unrelated condition, as this specific code indicates a direct relationship between the two conditions For E10.630, 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. One mnemonic element does not establish that a diagnosis is reportable.

2026 ICD-10-CM E10.630: Type 1 diabetes mellitus

E10.630 maps to CMS-HCC V28 37. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupE10.630

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E10.630

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Type 1 diabetes mellitus with periodontal disease

This code describes a patient with Type 1 diabetes who also has gum disease (periodontal disease), which is a complication that can occur when diabetes is not well-controlled. The combination of these two conditions requires documentation of both the diabetes and the gum disease for proper coding.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 37

Diabetes with Chronic Complic...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 30

Diabetes with Complications

Code-level coefficient reference

Code Book Path

Official

E10.6Type 1 diabetes mellitus with other specified complications E10.63Type 1 diabetes mellitus with oral complications E10.630Type 1 diabetes mellitus with periodontal disease

Inclusion Terms

Official

No inclusion terms are included in this display for E10.630. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for E10.630. Check the code and parent instructions in the Code Book.

Related Codes

Official

E10.638Type 1 diabetes mellitus with other oral complications

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

Official

No Code First sequencing instructions are included in this display for E10.630. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for E10.630. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for E10.630. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must link periodontal disease as a complication of Type 1 diabetes, not merely a coexisting condition.

The provider should include dental examination findings or referral to periodontist, gingival assessment, and any impact on glycemic control.

The type and severity of periodontal disease (gingivitis versus periodontitis) should be specified when available.

MEAT Support

HCC Buddy guidance

Documentation must link periodontal disease as a complication of Type 1 diabetes, not merely a coexisting condition.

The provider should include dental examination findings or referral to periodontist, gingival assessment, and any impact on glycemic control.

The type and severity of periodontal disease (gingivitis versus periodontitis) should be specified when available.

Audit Caution

HCC Buddy guidance

Do not assume all periodontal disease in diabetic patients is diabetes-related

the provider must establish the causal link. This combination code captures both conditions, so avoid coding the diabetes and periodontal disease separately when the relationship is documented. Query the provider if the documentation is ambiguous about the diabetes-periodontal connection.

Common Mistakes

HCC Buddy guidance

E10.638 (other oral complications) covers mouth conditions beyond periodontal disease.

K05.0-K05.6 (gingivitis and periodontitis codes) may be used as additional codes but do not replace the diabetes combination code.

E10.69 (other specified complication) should not be used when periodontal disease is specifically documented.

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 E10.630 an HCC code?

Yes. E10.630 (Type 1 diabetes mellitus with periodontal disease) maps to HCC 37, Diabetes with Chronic 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: E10.630 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: E10.630
Description: Type 1 diabetes mellitus with periodontal disease
HCC (V28): HCC 37 — Diabetes with Chronic Complications
RAF reference coefficient: 0.166
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 37, Diabetes with Chronic Complications

0.166

RxHCCHCC 30, Diabetes with Complications

Not separately weighted

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 E10.630 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E10.630

For E10.630, 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

E10.630 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with periodontal disease. This code describes a patient with Type 1 diabetes who also has gum disease (periodontal disease), which is a complication that can occur when diabetes is not well-controlled. The combination of these two conditions requires documentation of both the diabetes and the gum disease for proper coding. E10.630 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, E10.630 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E10.630; 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.

Verify that the medical record explicitly documents both Type 1 diabetes and periodontal disease; do not assume the connection without clear clinical documentation. For E10.630, 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 E10.630 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify that the medical record explicitly documents both Type 1 diabetes and periodontal disease; do not assume the connection without clear clinical documentation
•Ensure the periodontal disease is documented as a complication of the diabetes rather than a separate unrelated condition, as this specific code indicates a direct relationship between the two conditions

Clinical Significance

Type 1 diabetes mellitus with periodontal disease reflects the bidirectional relationship between diabetes and oral health, where hyperglycemia increases susceptibility to gum infections while periodontal inflammation worsens glycemic control. Diabetic patients have a significantly higher prevalence of severe periodontitis, which can lead to tooth loss and systemic inflammatory burden. This combination requires coordinated medical and dental management.

Documentation Requirements

✓Documentation must link periodontal disease as a complication of Type 1 diabetes, not merely a coexisting condition.
✓The provider should include dental examination findings or referral to periodontist, gingival assessment, and any impact on glycemic control.
✓The type and severity of periodontal disease (gingivitis versus periodontitis) should be specified when available.

Commonly Confused Codes

•E10.638 (other oral complications) covers mouth conditions beyond periodontal disease.
•K05.0-K05.6 (gingivitis and periodontitis codes) may be used as additional codes but do not replace the diabetes combination code.
•E10.69 (other specified complication) should not be used when periodontal disease is specifically documented.