E10.9
BillableType 1 diabetes mellitus without complications
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E10.9 an HCC code?
Yes. E10.9 maps to Diabetes without Complication under the CMS-HCC V28 risk adjustment model (and Diabetes without Complication 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 E10.9
For E10.9 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 E10.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E10.9 is the ICD-10-CM diagnosis code for type 1 diabetes mellitus without complications. Type 1 diabetes is a condition where the body cannot produce insulin, a hormone needed to control blood sugar levels. This code is used when a patient has Type 1 diabetes but does not currently have any serious complications like kidney disease, eye problems, or nerve damage. E10.9 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, E10.9 maps to Diabetes without Complication (HCC 38) with a community, non-dual, aged base RAF weight of 0.450. Under the older V24 model, E10.9 mapped to the same category but with a base RAF weight of 0.105 — 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 only when documentation confirms Type 1 diabetes with no documented complications; if any complications are present, use a more specific code from the E10.0-E10.8 range. Because E10.9 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 E10.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation confirms Type 1 diabetes with no documented complications; if any complications are present, use a more specific code from the E10.0-E10.8 range
- •Always verify the diabetes type in the medical record, as Type 1 (E10) is distinctly different from Type 2 (E11) and requires different coding
Clinical Significance
Type 1 diabetes mellitus without complications is used for patients with insulin-dependent diabetes who have no documented end-organ damage or other diabetic complications. Type 1 diabetes is an autoimmune condition requiring lifelong exogenous insulin therapy, and even without complications, these patients require ongoing monitoring for retinopathy, nephropathy, neuropathy, and cardiovascular disease to prevent future complications.
Documentation Requirements
- ✓Documentation must confirm Type 1 diabetes (not Type 2 or other forms) and explicitly state or imply no current complications.
- ✓The medical record should reflect that standard diabetic screening (eye exam, kidney function, foot exam) has been performed or ordered.
- ✓If any complications are identified during the encounter, a more specific complication code should be used instead.
Commonly Confused Codes
- •E11.9 (Type 2 diabetes without complications) is for non-insulin-dependent diabetes and should not be confused with Type
- •E10.65 (with hyperglycemia) should be used when poor glucose control is documented. Any E10.0-E10.8x code supersedes this code when complications are present. E13.9 (other specified diabetes without complications) covers secondary or atypical diabetes forms.