E11.620
BillableType 2 diabetes mellitus with diabetic dermatitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.620 an HCC code?
Yes. E11.620 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 E11.620
For E11.620 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 E11.620 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.620 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with diabetic dermatitis. Type 2 diabetes causing skin inflammation and irritation, typically resulting from high blood sugar levels. E11.620 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, E11.620 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, E11.620 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.
Document the specific type and location of dermatitis to support medical necessity. Because E11.620 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 E11.620 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type and location of dermatitis to support medical necessity
- •Ensure the dermatitis is confirmed as diabetic-related rather than another etiology
Clinical Significance
Type 2 diabetes mellitus with diabetic dermatitis encompasses inflammatory skin conditions directly attributable to diabetes, including necrobiosis lipoidica diabeticorum, diabetic dermopathy (shin spots), granuloma annulare, and diabetic thick skin. These skin manifestations often correlate with glycemic control quality and may serve as visible markers of underlying microvascular disease. While typically not life-threatening, they impact quality of life and may complicate wound healing.
Documentation Requirements
- ✓Documentation must identify the specific dermatitis condition and link it to Type 2 diabetes.
- ✓The provider should describe the location, appearance, extent, and any associated symptoms or functional impact.
- ✓Biopsy results should be included when obtained.
- ✓The record must clearly distinguish dermatitis (inflammatory skin changes) from ulceration (open wounds) and other skin complications.