E11.01 ICD-10-CM Code: Type 2 diabetes mellitus with hyperosmolarity with coma
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.01
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 36
RAF 0.166
CMS-HCC V24
MappedHCC 17
RAF 0.302
ACA/HHS
MappedHCC 19
Varies by metal level
ESRD/PACE
MappedHCC 17
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.01 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.01 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.01 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.01 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.01 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.01 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.01 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 E11.01 an HCC code?
Yes. E11.01 (Type 2 diabetes mellitus with hyperosmolarity with coma) maps to Diabetes with Severe Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E11.01 is billable and maps to V28 HCC 36, Diabetes with Severe Acute Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.01
- Description
- Type 2 diabetes mellitus with hyperosmolarity with coma
- HCC (V28)
- HCC 36 — Diabetes with Severe Acute 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 E11.01 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
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.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
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 Severe Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E11.01 maps to Diabetes with Acute Complications (HCC 17) 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.
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.
Commonly Confused Codes
- •E11.00 (without coma) is used when the patient remains conscious during the hyperosmolar episode.
- •E11.11 (ketoacidosis with coma) involves acidosis from ketone production, which is a different metabolic pathway.
- •R40.20 (unspecified coma) should not be used when the cause of coma is identified as diabetic hyperosmolarity.