E11.11
BillableType 2 diabetes mellitus with ketoacidosis with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.11 an HCC code?
Yes. E11.11 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 E11.11
For E11.11 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 E11.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.11 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with ketoacidosis with coma. Type 2 diabetes with ketoacidosis where dangerous acids accumulate in the blood and the patient is unconscious. This is a critical medical emergency. E11.11 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, E11.11 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, E11.11 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.
Confirm both ketoacidosis and coma are documented in the medical record. Because E11.11 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 E11.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm both ketoacidosis and coma are documented in the medical record
- •This represents a more severe presentation than E11.10; ensure coma status is clearly stated
Clinical Significance
Type 2 diabetes mellitus with ketoacidosis with coma is the most severe presentation of diabetic ketoacidosis in a Type 2 diabetic patient, where metabolic acidosis has progressed to cause loss of consciousness. This represents a critical medical emergency requiring intensive care unit admission, continuous insulin infusion, aggressive electrolyte and fluid management, and identification of the precipitating cause. The combination of DKA with coma carries significant mortality risk.
Documentation Requirements
- ✓Documentation must confirm Type 2 diabetes, ketoacidosis (with supporting lab values including pH, bicarbonate, anion gap, and ketone levels), and coma or loss of consciousness.
- ✓Glasgow Coma Scale score, intensive care admission documentation, precipitating factors, and detailed treatment records are required.
- ✓Serial laboratory monitoring should be documented.
Commonly Confused Codes
- •E11.10 (DKA without coma) is used when the patient maintains consciousness.
- •E11.01 (hyperosmolarity with coma) has a different metabolic mechanism without significant ketoacidosis.
- •E10.11 (Type 1 DKA with coma) is the Type 1 equivalent and requires confirmation of diabetes type.
- •E87.2 (acidosis) is a non-specific code that should not replace this combination code.