E11.51
BillableType 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.51 an HCC code?
Yes. E11.51 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model.
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 E11.51
For E11.51 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 E11.51 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.51 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene. Type 2 diabetes with narrowing or blockage of blood vessels in the legs and feet without tissue death (gangrene). This reduces blood flow and can cause pain, poor wound healing, or cold extremities. E11.51 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, E11.51 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. E11.51 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
Confirm that gangrene is NOT present; if gangrene exists, use E11.52 instead. Because E11.51 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 E11.51 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm that gangrene is NOT present; if gangrene exists, use E11.52 instead
- •Document the location and severity of peripheral angiopathy when available to support treatment decisions
Clinical Significance
Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene reflects macrovascular disease where chronic hyperglycemia accelerates atherosclerosis in the peripheral arterial system. This condition causes intermittent claudication, rest pain, and poor wound healing, significantly increasing the risk for ulceration and amputation. Peripheral arterial disease in diabetic patients tends to affect more distal vessels compared to non-diabetic patients, making surgical revascularization more challenging.
Documentation Requirements
- ✓Documentation must confirm peripheral angiopathy as a complication of Type 2 diabetes and explicitly state that gangrene is absent.
- ✓Vascular assessment including ankle-brachial index, pulse examination, or arterial duplex ultrasound findings should be recorded.
- ✓Symptom severity (Fontaine classification or Rutherford category) and treatment plan including medication, exercise therapy, or revascularization referral should be documented.