E11.10
BillableType 2 diabetes mellitus with ketoacidosis without coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.10 an HCC code?
Yes. E11.10 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 E11.10
For E11.10 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 E11.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.10 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with ketoacidosis without coma. Type 2 diabetes with ketoacidosis, a serious condition where acids build up in the blood due to improper insulin function, but the patient remains conscious. E11.10 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, E11.10 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, E11.10 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 ketoacidosis is documented and that the patient is NOT in a coma before assigning this code. Because E11.10 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 E11.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that ketoacidosis is documented and that the patient is NOT in a coma before assigning this code
- •If coma is present, use E11.11 instead
Clinical Significance
Type 2 diabetes mellitus with ketoacidosis without coma is a serious acute metabolic complication where insulin deficiency leads to excessive fatty acid breakdown and ketone body accumulation, resulting in metabolic acidosis. While more common in Type 1 diabetes, DKA in Type 2 diabetes is increasingly recognized, particularly in patients with ketosis-prone Type 2 diabetes or during severe physiological stress. This condition requires urgent hospital-based management.
Documentation Requirements
- ✓Documentation must confirm both Type 2 diabetes and diabetic ketoacidosis with the patient remaining conscious.
- ✓Laboratory values including blood glucose, arterial blood gas, serum ketones, anion gap, and bicarbonate levels should be recorded.
- ✓The precipitating factor (infection, medication non-compliance, new onset) and treatment protocol must be documented.
Commonly Confused Codes
- •E11.11 (ketoacidosis with coma) is used when loss of consciousness occurs.
- •E11.00/E11.01 (hyperosmolarity) involve extreme dehydration without significant ketoacidosis.
- •E10.10 (Type 1 DKA without coma) is the equivalent code for Type 1 diabetes and should not be confused.
- •E11.65 (hyperglycemia) does not capture the acidosis component.