E11.01
BillableType 2 diabetes mellitus with hyperosmolarity with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.01 an HCC code?
Yes. E11.01 maps to Diabetes with Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute 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 E11.01
For E11.01 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 E11.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.01 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with hyperosmolarity with coma. Type 2 diabetes with a dangerous condition where blood becomes too concentrated (hyperosmolarity) and the patient is unconscious. This is a medical emergency requiring immediate treatment. E11.01 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, E11.01 maps to Diabetes with Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.390. Under the older V24 model, E11.01 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.
This code indicates a life-threatening complication; ensure the coma status is documented in the medical record. Because E11.01 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 E11.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates a life-threatening complication; ensure the coma status is documented in the medical record
- •Do not use this code if the patient is conscious or alert; use E11.00 instead
Clinical Significance
Type 2 diabetes mellitus with hyperosmolarity with coma represents the most severe form of hyperosmolar hyperglycemic state, where extreme dehydration and metabolic derangement have caused loss of consciousness. This is a medical emergency with mortality rates exceeding 20%, requiring immediate intensive care management. Patients present with extreme hyperglycemia (often above 800 mg/dL), profound dehydration, and neurological deterioration.
Documentation Requirements
- ✓The medical record must document coma or loss of consciousness in the setting of diabetic hyperosmolarity in a Type 2 diabetic patient.
- ✓Blood glucose, serum osmolarity, renal function, and electrolyte values should be recorded.
- ✓Glasgow Coma Scale or other consciousness assessment, intensive care unit admission notes, and treatment with aggressive fluid resuscitation and insulin therapy must be documented.