E11.42
BillableType 2 diabetes mellitus with diabetic polyneuropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.42 an HCC code?
Yes. E11.42 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 E11.42
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.
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 0.245. 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.
Polyneuropathy is the most common form of diabetic neuropathy; document the distribution and severity when documented. 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
- •Polyneuropathy is the most common form of diabetic neuropathy; document the distribution and severity when documented
- •Consider if patient has symptoms in multiple extremities to differentiate from mononeuropathy
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.