E11.610
BillableType 2 diabetes mellitus with diabetic neuropathic arthropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.610 an HCC code?
Yes. E11.610 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 E11.610
For E11.610 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 E11.610 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.610 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic neuropathic arthropathy. Type 2 diabetes with diabetic neuropathic arthropathy (Charcot joint), a condition where nerve damage causes progressive joint destruction, typically in the feet. This results in joint deformity and instability. E11.610 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, E11.610 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, E11.610 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.
Neuropathic arthropathy requires documentation of both neuropathy and joint involvement; verify both are present. Because E11.610 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 E11.610 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Neuropathic arthropathy requires documentation of both neuropathy and joint involvement; verify both are present
- •Document which joints are affected and the stage of arthropathy when documented to support orthotic or surgical interventions
Clinical Significance
Type 2 diabetes mellitus with diabetic neuropathic arthropathy (Charcot joint) is a destructive joint condition resulting from diabetic peripheral neuropathy, most commonly affecting the midfoot and ankle. Loss of protective sensation leads to repetitive unrecognized trauma, progressive bone fragmentation, joint collapse, and severe deformity. Early recognition during the acute inflammatory phase is critical for preventing irreversible structural damage through offloading and immobilization.
Documentation Requirements
- ✓Documentation must identify neuropathic arthropathy as a complication of Type 2 diabetes, specifying the affected joint(s) and the clinical or radiographic stage.
- ✓Imaging findings including bone fragmentation, subluxation, joint effusion, or coalescence should be described.
- ✓The Eichenholtz staging system (dissolution, coalescence, reconstruction) should be used when possible.
- ✓Treatment documentation should note total contact casting, surgical stabilization, or custom orthotic prescriptions.
Commonly Confused Codes
- •E11.618 (other diabetic arthropathy) covers non-neuropathic joint conditions.
- •E11.42 (polyneuropathy) captures the underlying nerve damage without the joint destruction component.
- •M14.60 (Charcot joint) is a manifestation code that may supplement but not replace this combination code.
- •E11.621 (foot ulcer) may coexist with Charcot foot but captures a different complication.