E10.649 ICD-10-CM Code: Type 1 diabetes mellitus with hypoglycemia without coma
E10.649 maps to CMS-HCC V28 38 (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)
E10.649
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 1 diabetes mellitus with hypoglycemia without coma
Type 1 diabetes with low blood sugar levels that did not result in loss of consciousness.
Buddy Insight
Type 1 diabetes mellitus with hypoglycemia without coma captures episodes of dangerously low blood glucose where the patient maintains consciousness.
CMS-HCC V28
MappedHCC 38
RAF 0.166
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E10.649 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E10.649 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E10.649 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E10.649 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E10.649 in this effective period.
Use Additional
Official- code for hypoglycemia level, if applicable (E16.A-)
Code Also
OfficialICD-10-CM does not list Code Also instructions for E10.649 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 E10.649 an HCC code?
Yes. E10.649 (Type 1 diabetes mellitus with hypoglycemia without coma) maps to Diabetes with No, Glycemic, or Unspecified 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: E10.649 is billable and maps to V28 HCC 38, Diabetes with No, Glycemic, or Unspecified Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E10.649
- Description
- Type 1 diabetes mellitus with hypoglycemia without coma
- HCC (V28)
- HCC 38 — Diabetes with No, Glycemic, or Unspecified 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 E10.649 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E10.649
For E10.649 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 E10.649 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E10.649 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus with hypoglycemia without coma. Type 1 diabetes with low blood sugar levels that did not result in loss of consciousness. E10.649 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, E10.649 maps to Diabetes with No, Glycemic, or Unspecified Complications (HCC 38) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E10.649 maps to Diabetes with Chronic Complications (HCC 18) with a community, non-dual, aged base RAF weight of 0.302. 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.
Document whether hypoglycemia was mild, moderate, or severe to support medical necessity. Because E10.649 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 E10.649 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether hypoglycemia was mild, moderate, or severe to support medical necessity
- •Distinguish from E10.641 by confirming the patient remained conscious during the episode
Clinical Significance
Type 1 diabetes mellitus with hypoglycemia without coma captures episodes of dangerously low blood glucose where the patient maintains consciousness. Recurrent hypoglycemia is a common and significant barrier to optimal glycemic control in Type 1 diabetes, leading to hypoglycemia unawareness, impaired counter-regulatory responses, and reduced quality of life. Documentation of these episodes is critical for insulin dose adjustments and technology interventions such as continuous glucose monitoring.
Documentation Requirements
- ✓The record must document a hypoglycemic episode in a Type 1 diabetic patient with confirmation that coma did not occur.
- ✓Blood glucose readings, symptoms experienced (tremor, diaphoresis, confusion), and treatment provided should be recorded.
- ✓Frequency of hypoglycemic episodes and any pattern analysis should be noted for management planning.
Commonly Confused Codes
- •E10.641 (hypoglycemia with coma) is used when loss of consciousness occurs and maps to a different, higher-weighted HCC.
- •E10.65 (hyperglycemia) is the opposite metabolic derangement with high blood sugar.
- •E16.0 (drug-induced hypoglycemia without coma) is used for non-diabetic medication-induced low blood sugar.