E11.40 ICD-10-CM Code: Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.40 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)
E11.40
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with diabetic neuropathy, unspecified
Type 2 diabetes with nerve damage (neuropathy) that is not further specified. This occurs when high blood sugar levels damage nerves throughout the body.
Buddy Insight
Type 2 diabetes mellitus with diabetic neuropathy, unspecified, indicates nerve damage from diabetes where the specific type of neuropathy has not been further characterized.
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 E11.40 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.40 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.40 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.40 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.40 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.40 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.40 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 E11.40 an HCC code?
Yes. E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified) 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: E11.40 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
- E11.40
- Description
- Type 2 diabetes mellitus with diabetic neuropathy, unspecified
- 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 E11.40 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E11.40
For E11.40 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 E11.40 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E11.40 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic neuropathy, unspecified. Type 2 diabetes with nerve damage (neuropathy) that is not further specified. This occurs when high blood sugar levels damage nerves throughout the body. E11.40 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, E11.40 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, E11.40 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.
Provider must document diabetic neuropathy without specifying type. A monofilament exam showing decreased sensation, a mention of 'diabetic peripheral neuropathy', or ongoing gabapentin/duloxetine for diabetic nerve pain all support the code when the clinical link is charted. Because E11.40 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 E11.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Provider must document diabetic neuropathy without specifying type. A monofilament exam showing decreased sensation, a mention of 'diabetic peripheral neuropathy', or ongoing gabapentin/duloxetine for diabetic nerve pain all support the code when the clinical link is charted.
- •If the documentation specifies polyneuropathy, autonomic neuropathy, amyotrophy, or mononeuropathy, use E11.42, E11.43, E11.44, or E11.41 instead. E11.40 is the unspecified choice and should be the last resort when a more specific child code fits the note.
- •V28 HCC 37 at RAF 0.166. Diabetic neuropathy is one of the most commonly under-documented complications; reviewing neuro exam findings and current pain-management regimens is a high-yield query target.
Clinical Significance
Type 2 diabetes mellitus with diabetic neuropathy, unspecified, indicates nerve damage from diabetes where the specific type of neuropathy has not been further characterized. Diabetic neuropathy affects approximately 50% of patients with long-standing diabetes and is the primary risk factor for diabetic foot ulceration and amputation. Even without type specification, documentation of neuropathy signals the need for foot care programs, pain management, and fall prevention strategies.
Documentation Requirements
- ✓Documentation must confirm diabetic neuropathy in a Type 2 diabetic patient.
- ✓Neurological examination findings including sensory testing (monofilament, vibration), reflexes, and motor function should be recorded.
- ✓Providers should be queried to specify the neuropathy type (peripheral, autonomic, mononeuropathy, polyneuropathy) to enable more precise coding.
- ✓Treatment with neuropathic pain medications should be noted.
Commonly Confused Codes
- •E11.41 (mononeuropathy) is for single-nerve involvement.
- •E11.42 (polyneuropathy) captures the most common form with multiple-nerve damage.
- •E11.43 (autonomic neuropathy) involves involuntary nervous system dysfunction.
- •E11.44 (amyotrophy) includes muscle wasting.
- •All of these are more specific than E11.40 and should be used when documented.