E11.52 ICD-10-CM Code: Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene

Code

E11.52

Description

Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene

HCC (V28)

HCC 37 — Diabetes with Chronic Complications; HCC 263 — Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene

RAF reference coefficient

HCC 37: 0.166; HCC 263: 1.118

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 E11.52 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E11.52

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E11.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Type 2 diabetes with diabetic peripheral angiopathy with gangrene. Documentation must establish both diabetic vasculopathy and current gangrene, a vascular exam finding with dusky/necrotic tissue attributed to diabetic ischemia.
• •Do not use E11.52 for non-diabetic gangrene, the diabetic etiology must be documented or supported by the 'with' assumed-relationship convention. Also distinguish from E11.51 (angiopathy without gangrene) and from I70.26x (non-diabetic atherosclerosis with gangrene).
• •The official CY2026 final mapping lists V28 HCC 37 and HCC 263 for E11.52. Treat both as mapping status, then apply hierarchy rules and member-segment coefficients to the complete diagnosis set.

Clinical Significance

Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene represents the most severe macrovascular complication where peripheral arterial insufficiency has progressed to tissue death. This is a limb-threatening and potentially life-threatening emergency requiring urgent vascular assessment and often surgical intervention including debridement, revascularization, or amputation. The mortality rate within five years of diabetic gangrene diagnosis is substantial.

Documentation Requirements

• ✓Documentation must confirm gangrene in the setting of diabetic peripheral angiopathy in a Type 2 diabetic patient.
• ✓The location, extent, type (dry or wet), and associated findings (infection, osteomyelitis) must be recorded.
• ✓Vascular imaging results, surgical consultation notes, and operative reports are essential supporting documentation.
• ✓Wound care progress and any amputation decisions should be thoroughly documented.

Commonly Confused Codes

• •E11.51 (without gangrene) is used when peripheral vascular disease is present without tissue necrosis.
• •I96 (gangrene, not elsewhere classified) should not replace this combination code.
• •L97 series (non-pressure chronic ulcer) may be used additionally for ulcer site specificity but does not capture gangrene.
• •E11.621 (foot ulcer) represents a less severe wound complication.

Child Codes