E11.22 ICD-10-CM Code: Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.22 maps to CMS-HCC V28 37 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.22
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with diabetic chronic kidney disease
Type 2 diabetes with chronic kidney disease, meaning the kidneys have long-term damage from diabetes and are not functioning properly.
Buddy Insight
Type 2 diabetes mellitus with diabetic chronic kidney disease captures the progressive renal impairment that develops from sustained hyperglycemic damage to the renal microvasculature.
CMS-HCC V28
MappedHCC 37
RAF 0.166
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
MappedHCC 20
Varies by metal level
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.22 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.22 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.22 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.22 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.22 in this effective period.
Use Additional
Official- code to identify stage of chronic kidney disease (N18.1-N18.6)
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.22 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 E11.22 an HCC code?
Yes. E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E11.22 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.22
- Description
- Type 2 diabetes mellitus with diabetic chronic kidney disease
- HCC (V28)
- HCC 37 — Diabetes with Chronic 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 E11.22 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E11.22
For E11.22 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 E11.22 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E11.22 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic chronic kidney disease. Type 2 diabetes with chronic kidney disease, meaning the kidneys have long-term damage from diabetes and are not functioning properly. E11.22 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, E11.22 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.166. Under the older V24 model, E11.22 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.
Documentation must state the causal relationship between diabetes and CKD, or the provider must document both conditions and the code rules in ICD-10-CM allow an assumed relationship. N18.x for the CKD stage must also be coded, E11.22 does not capture the stage on its own. Because E11.22 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 E11.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Documentation must state the causal relationship between diabetes and CKD, or the provider must document both conditions and the code rules in ICD-10-CM allow an assumed relationship. N18.x for the CKD stage must also be coded, E11.22 does not capture the stage on its own.
- •Do not report E11.22 without a specific N18 stage code. 'Use additional code' convention at E11.22 requires N18.1 through N18.6 to identify stage; coding E11.22 alone is incomplete and common audit finding.
- •V28 HCC 37 (Diabetes with Chronic Complications) at RAF 0.166. The paired N18.4, N18.5, or N18.6 then captures HCC 327 or HCC 326 on top, this is one of the highest-yield diabetes combinations for accurate RAF capture.
Clinical Significance
Type 2 diabetes mellitus with diabetic chronic kidney disease captures the progressive renal impairment that develops from sustained hyperglycemic damage to the renal microvasculature. This code is distinct from nephropathy in that it explicitly documents the chronic kidney disease classification, indicating established and ongoing renal function decline. These patients face increased cardiovascular risk, medication dosing challenges, and potential need for renal replacement therapy.
Documentation Requirements
- ✓The provider must document chronic kidney disease as a complication of Type 2 diabetes.
- ✓The CKD stage (1 through 5) should be specified with an additional N18 code.
- ✓Documentation should include estimated glomerular filtration rate, urinary protein quantification, and renal management plan.
- ✓The causal relationship between diabetes and the chronic kidney disease must be explicitly stated or clearly implied.
Commonly Confused Codes
- •E11.21 (diabetic nephropathy) is a broader term that may or may not include staged chronic kidney disease.
- •E11.29 (other diabetic kidney complication) covers renal conditions beyond nephropathy and CKD.
- •N18.1-N18.6 are additional staging codes that should accompany this code.
- •N18.9 (unspecified CKD) should prompt a query for stage specificity.