E11.43 ICD-10-CM Code: Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.43 maps to CMS-HCC V28 37. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. 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)
E11.43
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
Type 2 diabetes with damage to the autonomic nerves that control involuntary body functions like heart rate, digestion, and blood pressure. This can cause dizziness, digestive problems, or irregular heartbeat.
Buddy Insight
Type 2 diabetes mellitus with diabetic autonomic neuropathy reflects damage to the nerves controlling involuntary body functions, including cardiovascular regulation, gastrointestinal motility, bladder function, and sudomotor activity.
CMS-HCC V28
MappedHCC 37
Coefficient HCC 37: 0.166 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 020
Code-level coefficient reference
ESRD/PACE
MappedHCC 18
Code-level coefficient reference
RXHCC
MappedHCC 30
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Type 2 diabetes mellitus with diabetic gastroparesis
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E11.43. Check the code and parent instructions in the Code Book.
Related Codes
Includes
Official- diabetes (mellitus) due to insulin secretory defectInherited from E11
- diabetes NOSInherited from E11
- insulin resistant diabetes (mellitus)Inherited from E11
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E11
- diabetes mellitus due to underlying condition (E08.-)Inherited from E00-E89, E11
- drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E11
- gestational diabetes (O24.4-)Inherited from E00-E89, E11
- neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E11
- postpancreatectomy diabetes mellitus (E13.-)Inherited from E00-E89, E11
- postprocedural diabetes mellitus (E13.-)Inherited from E00-E89, E11
- secondary diabetes mellitus NEC (E13.-)Inherited from E00-E89, E11
- type 1 diabetes mellitus (E10.-)Inherited from E00-E89, E11
Code First
OfficialNo Code First sequencing instructions are included in this display for E11.43. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify control using:Inherited from E11
- injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E11
- insulin (Z79.4)Inherited from E11
- oral antidiabetic drugs (Z79.84)Inherited from E11
- oral hypoglycemic drugs (Z79.84)Inherited from E11
Code Also
OfficialNo Code Also instructions are included in this display for E11.43. Check the code and parent instructions in the Code Book.
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 E11.43 an HCC code?
Yes. E11.43 (Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy) maps to HCC 37, Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.166. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: E11.43 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
- E11.43
- Description
- Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications
- RAF reference coefficient
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work E11.43 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E11.43
For E11.43, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
E11.43 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy. Type 2 diabetes with damage to the autonomic nerves that control involuntary body functions like heart rate, digestion, and blood pressure. This can cause dizziness, digestive problems, or irregular heartbeat. E11.43 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, E11.43 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction when present. For E11.43, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for E11.43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction when present
- •Autonomic neuropathy may coexist with other neuropathy types; code all documented types
Clinical Significance
Type 2 diabetes mellitus with diabetic autonomic neuropathy reflects damage to the nerves controlling involuntary body functions, including cardiovascular regulation, gastrointestinal motility, bladder function, and sudomotor activity. Cardiac autonomic neuropathy is associated with increased mortality risk from silent myocardial ischemia and arrhythmias. Gastroparesis significantly impacts glycemic control by causing unpredictable nutrient absorption.
Documentation Requirements
- ✓Documentation must identify autonomic neuropathy as a complication of Type 2 diabetes, specifying which autonomic systems are affected.
- ✓Cardiac autonomic testing (heart rate variability, orthostatic blood pressure), gastric emptying studies, urodynamic testing, or sudomotor function tests should be documented as applicable.
- ✓Symptoms such as orthostatic hypotension, gastroparesis, or neurogenic bladder should be described.
Commonly Confused Codes
- •E11.42 (polyneuropathy) affects sensory and motor nerves rather than autonomic nerves.
- •E11.40 (unspecified neuropathy) should not be used when autonomic involvement is specifically documented.
- •K31.84 (gastroparesis) may be used as an additional code alongside this combination code.
- •I95.1 (orthostatic hypotension) may be coded additionally when present.