E11.40
BillableType 2 diabetes mellitus with diabetic neuropathy, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.40 an HCC code?
Yes. E11.40 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic 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 E11.40
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.
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 0.245. 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.
Use this code only when the type of diabetic neuropathy is not documented; if specific neuropathy type is identified, use more specific codes E11.41-E11.49. 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
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.