E11.618
BillableType 2 diabetes mellitus with other diabetic arthropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.618 an HCC code?
Yes. E11.618 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 E11.618
For E11.618 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 E11.618 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.618 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with other diabetic arthropathy. Type 2 diabetes that causes joint and bone problems, including arthritis-like conditions affecting the joints. E11.618 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, E11.618 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, E11.618 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.
Specify which joint(s) are affected when documentation is available to ensure accurate coding. Because E11.618 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 E11.618 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify which joint(s) are affected when documentation is available to ensure accurate coding
- •Distinguish from other arthropathies by confirming the condition is directly related to diabetes
Clinical Significance
Type 2 diabetes mellitus with other diabetic arthropathy covers joint disorders caused by diabetes that are not neuropathic arthropathy, including diabetic cheiroarthropathy (limited joint mobility of the hands), adhesive capsulitis (frozen shoulder), Dupuytren contracture, and other connective tissue changes from glycosylation of collagen. These conditions reflect the systemic effects of chronic hyperglycemia on musculoskeletal structures.
Documentation Requirements
- ✓The provider must document the specific arthropathy and establish its causal relationship to Type 2 diabetes.
- ✓Affected joints, range of motion measurements, functional impact, and treatment plans should be recorded.
- ✓The documentation must distinguish this from neuropathic arthropathy (E11.610) and from primary musculoskeletal conditions unrelated to diabetes.
Commonly Confused Codes
- •E11.610 (neuropathic arthropathy) specifically covers Charcot joint and has different clinical implications.
- •M25.60 (stiffness of joint) does not capture the diabetic etiology.
- •E11.69 (other specified complication) is too broad when the complication is specifically an arthropathy.
- •M13.80 (other specified arthritis) does not capture the diabetes-arthropathy relationship.