E11.44
BillableType 2 diabetes mellitus with diabetic amyotrophy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.44 an HCC code?
Yes. E11.44 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 E11.44
For E11.44 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 E11.44 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.44 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic amyotrophy. Type 2 diabetes with muscle weakness and wasting (amyotrophy) caused by nerve damage, typically affecting the thigh muscles. This results in weakness and difficulty with movement. E11.44 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, E11.44 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, E11.44 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.
Amyotrophy is characterized by muscle atrophy and weakness; ensure documentation specifies muscle involvement rather than just neuropathy. Because E11.44 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 E11.44 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Amyotrophy is characterized by muscle atrophy and weakness; ensure documentation specifies muscle involvement rather than just neuropathy
- •This condition may require physical therapy documentation to support medical necessity
Clinical Significance
Type 2 diabetes mellitus with diabetic amyotrophy is an uncommon but debilitating neurological complication characterized by acute onset of severe pain in the thigh followed by progressive proximal muscle weakness and atrophy. Also called diabetic lumbosacral radiculoplexus neuropathy or Bruns-Garland syndrome, it results from inflammatory vasculopathy of the nerve vasculature. Unlike polyneuropathy, amyotrophy tends to be asymmetric and may partially or fully resolve over months to years.
Documentation Requirements
- ✓Documentation must clearly identify amyotrophy as a diabetic complication in a Type 2 diabetic patient, describing the affected muscle groups, degree of atrophy, functional limitations, and pain severity.
- ✓Electromyography and nerve conduction studies are key diagnostic tests that should be documented.
- ✓Differential diagnosis excluding other causes of proximal weakness (such as inflammatory myopathy) should be noted.
Commonly Confused Codes
- •E11.42 (polyneuropathy) is a symmetric distal neuropathy, whereas amyotrophy is typically asymmetric and proximal.
- •E11.40 (unspecified neuropathy) should not be used when amyotrophy is specifically documented.
- •G73.0 (myasthenic syndromes in endocrine diseases) involves neuromuscular junction dysfunction, not nerve-mediated muscle wasting.
- •M62.50 (muscle wasting, unspecified) does not capture the diabetic etiology.