E11.43
BillableType 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.43 an HCC code?
Yes. E11.43 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 E11.43
For E11.43 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 E11.43 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E11.43 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.
Document specific autonomic symptoms such as orthostatic hypotension, gastroparesis, or cardiac dysfunction when present. Because E11.43 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 E11.43 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.