E11.52
BillableType 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.52 an HCC code?
No. E11.52 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 E11.52
For E11.52 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 E11.52 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.52 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene. Type 2 diabetes with narrowing or blockage of blood vessels in the legs and feet WITH tissue death (gangrene). This is a serious condition requiring urgent intervention to prevent amputation. E11.52 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
E11.52 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Does not map to an HCC in V28, V24, or ESRD models. This is a notable risk adjustment gap for one of the most severe diabetic complications. Coders must capture all concurrent conditions (vascular disease codes, amputation status, infection, chronic kidney disease) to ensure appropriate risk profiling.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, 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
- •Gangrene is a serious complication; ensure documentation clearly states gangrene is present before coding this
- •Document the extent and location of gangrene; coordinate with wound care and vascular surgery documentation
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.