What is the ICD-10 code for DM with polyneuropathy?

The ICD-10-CM code for DM with polyneuropathy (type 2 diabetes mellitus with diabetic polyneuropathy) is E11.42. E11.42 is a billable diagnosis code in the FY2026 ICD-10-CM code set used on Medicare Advantage and commercial claims. It maps to CMS-HCC V28 category 37 (RAF 0.166), so it counts toward the patient's risk adjustment score.

What is ICD-10 code E11.42?

E11.42 is the ICD-10-CM diagnosis code for Type 2 diabetes mellitus with diabetic polyneuropathy. Type 2 diabetes with damage to multiple nerves (polyneuropathy), typically affecting both sides of the body symmetrically. This commonly causes numbness, tingling, or weakness in the feet and hands. E11.42 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E11.42 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E11.42 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E11.42 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for E11.42?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For E11.42, V28 maps to Diabetes with Chronic Complications at RAF 0.166 while V24 mapped to Diabetes with Chronic Complications at RAF 0.302. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting E11.42?

Documentation must state diabetic polyneuropathy specifically, multi-limb stocking-glove distribution, or an explicit 'diabetic polyneuropathy' statement from the provider. A single-nerve finding does not support E11.42; that would be E11.41. Do not confuse E11.42 with E11.40. Polyneuropathy means multiple peripheral nerves involved; unspecified neuropathy is a lesser specificity and still carries the same HCC 37 status but may be harder to defend in audit. V28 HCC 37 at RAF 0.166. For documented polyneuropathy, E11.42 is the correct specificity and should replace E11.40 whenever the provider narrative supports it. Because E11.42 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM E11.42: Type 2 diabetes mellitus

ICD-10-CM Code View

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Code lookupE11.42Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E11.42

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Type 2 diabetes mellitus with diabetic polyneuropathy

Type 2 diabetes with damage to multiple nerves (polyneuropathy), typically affecting both sides of the body symmetrically. This commonly causes numbness, tingling, or weakness in the feet and hands.

Buddy Insight

Type 2 diabetes mellitus with diabetic polyneuropathy is the most prevalent form of diabetic neuropathy, affecting both sides of the body symmetrically in a 'stocking-glove' distribution.

CMS-HCC V28

Mapped

HCC 37

Diabetes with Chronic Complic...

RAF 0.166

CMS-HCC V24

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.302

ACA/HHS

Mapped

HCC 20

HHS-HCC 20

Varies by metal level

ESRD/PACE

Mapped

HCC 18

Diabetes with Chronic Complic...

RAF 0.084

RXHCC

Mapped

HCC 30

Diabetes with Complications

RAF 0.495

Code Book Path

Official

E11Type 2 diabetes mellitus

E11.4Type 2 diabetes mellitus with neurological complications

E11.42Type 2 diabetes mellitus with diabetic polyneuropathy

Inclusion Terms

Official

Type 2 diabetes mellitus with diabetic neuralgia

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E11.42 in this effective period.

Related Child Codes

Official

E11.40Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41Type 2 diabetes mellitus with diabetic mononeuropathy

E11.43Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44Type 2 diabetes mellitus with diabetic amyotrophy

E11.49Type 2 diabetes mellitus with other diabetic neurological complication

Includes

Official

ICD-10-CM does not list Includes notes for E11.42 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E11.42 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E11.42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E11.42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E11.42 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must confirm polyneuropathy as a complication of Type 2 diabetes, describing the distribution pattern, severity, and functional impact.

Neurological examination findings including monofilament testing, vibration perception, ankle reflexes, and pain assessment should be recorded.

Nerve conduction study results, if performed, should be included.

Foot care plans and neuropathic pain management should be documented.

MEAT Support

HCC Buddy guidance

Documentation must confirm polyneuropathy as a complication of Type 2 diabetes, describing the distribution pattern, severity, and functional impact.

Neurological examination findings including monofilament testing, vibration perception, ankle reflexes, and pain assessment should be recorded.

Nerve conduction study results, if performed, should be included.

Foot care plans and neuropathic pain management should be documented.

Audit Caution

HCC Buddy guidance

Do not default to unspecified neuropathy (E11.40) when documentation clearly describes bilateral symmetric sensory loss consistent with polyneuropathy. Polyneuropathy and peripheral neuropathy are often used interchangeably in clinical documentation

both support this code. When polyneuropathy coexists with autonomic neuropathy, code both conditions.

Common Mistakes

HCC Buddy guidance

E11.41 (mononeuropathy) affects a single nerve, unlike the symmetric multi-nerve pattern of polyneuropathy.

E11.43 (autonomic neuropathy) involves involuntary nervous system functions.

E11.40 (unspecified neuropathy) should not be used when polyneuropathy is specifically documented.

G62.9 (polyneuropathy, unspecified) does not capture the diabetic etiology.

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 E11.42 an HCC code?

Yes. E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy) 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: E11.42 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: E11.42
Description: Type 2 diabetes mellitus with diabetic polyneuropathy
HCC (V28): HCC 37 — Diabetes with Chronic Complications
RAF: 0.166
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 37, Diabetes with Chronic Complications

0.166

V24HCC 18, Diabetes with Chronic Complications

0.302

ESRDHCC 18, Diabetes with Chronic Complications

0.084

RxHCCHCC 30, Diabetes with Complications

0.495

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 E11.42 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E11.42

For E11.42 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 E11.42 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E11.42 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic polyneuropathy. Type 2 diabetes with damage to multiple nerves (polyneuropathy), typically affecting both sides of the body symmetrically. This commonly causes numbness, tingling, or weakness in the feet and hands. E11.42 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, E11.42 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, E11.42 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 diabetic polyneuropathy specifically, multi-limb stocking-glove distribution, or an explicit 'diabetic polyneuropathy' statement from the provider. A single-nerve finding does not support E11.42; that would be E11.41. Because E11.42 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 E11.42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Documentation must state diabetic polyneuropathy specifically, multi-limb stocking-glove distribution, or an explicit 'diabetic polyneuropathy' statement from the provider. A single-nerve finding does not support E11.42; that would be E11.41.
•Do not confuse E11.42 with E11.40. Polyneuropathy means multiple peripheral nerves involved; unspecified neuropathy is a lesser specificity and still carries the same HCC 37 status but may be harder to defend in audit.
•V28 HCC 37 at RAF 0.166. For documented polyneuropathy, E11.42 is the correct specificity and should replace E11.40 whenever the provider narrative supports it.

Clinical Significance

Type 2 diabetes mellitus with diabetic polyneuropathy is the most prevalent form of diabetic neuropathy, affecting both sides of the body symmetrically in a 'stocking-glove' distribution. This condition causes progressive numbness, tingling, burning pain, and loss of protective sensation in the feet and hands. It is the leading predisposing factor for diabetic foot ulcers and non-traumatic lower extremity amputations, making it one of the most clinically significant diabetic complications.

Documentation Requirements

✓Documentation must confirm polyneuropathy as a complication of Type 2 diabetes, describing the distribution pattern, severity, and functional impact.
✓Neurological examination findings including monofilament testing, vibration perception, ankle reflexes, and pain assessment should be recorded.
✓Nerve conduction study results, if performed, should be included.
✓Foot care plans and neuropathic pain management should be documented.

Commonly Confused Codes

•E11.41 (mononeuropathy) affects a single nerve, unlike the symmetric multi-nerve pattern of polyneuropathy.
•E11.43 (autonomic neuropathy) involves involuntary nervous system functions.
•E11.40 (unspecified neuropathy) should not be used when polyneuropathy is specifically documented.
•G62.9 (polyneuropathy, unspecified) does not capture the diabetic etiology.