E10.630
BillableType 1 diabetes mellitus with periodontal disease
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.630 an HCC code?
Yes. E10.630 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 E10.630
For E10.630 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 E10.630 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E10.630 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.
Verify that the medical record explicitly documents both Type 1 diabetes and periodontal disease; do not assume the connection without clear clinical documentation. Because E10.630 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 E10.630 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.