E11.621 ICD-10-CM Code: Type 2 diabetes mellitus with foot ulcer
E11.621 maps to CMS-HCC V28 HCCs 37 and 383. Source-labeled RAF references are available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.621
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with foot ulcer
Type 2 diabetes resulting in an open sore or wound on the foot that fails to heal properly.
Buddy Insight
Type 2 diabetes mellitus with foot ulcer is one of the most clinically significant diabetic complications, representing the primary pathway to non-traumatic lower extremity amputation.
CMS-HCC V28
MappedHCC 37
Coefficient HCC 37: 0.166 (Community Non-Dual Aged (CNA)); HCC 383: 0.646 (Community Non-Dual Aged (CNA))
+ HCC 383
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 020
Code-level coefficient reference
ESRD/PACE
MappedHCC 18
Code-level coefficient reference
+ HCC 161
RXHCC
MappedHCC 30
Code-level coefficient reference
+ HCC 311
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for E11.621. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E11.621. Check the code and parent instructions in the Code Book.
Related Codes
Includes
Official- diabetes (mellitus) due to insulin secretory defectInherited from E11
- diabetes NOSInherited from E11
- insulin resistant diabetes (mellitus)Inherited from E11
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E11
- diabetes mellitus due to underlying condition (E08.-)Inherited from E00-E89, E11
- drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E11
- gestational diabetes (O24.4-)Inherited from E00-E89, E11
- neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E11
- postpancreatectomy diabetes mellitus (E13.-)Inherited from E00-E89, E11
- postprocedural diabetes mellitus (E13.-)Inherited from E00-E89, E11
- secondary diabetes mellitus NEC (E13.-)Inherited from E00-E89, E11
- type 1 diabetes mellitus (E10.-)Inherited from E00-E89, E11
Code First
OfficialNo Code First sequencing instructions are included in this display for E11.621. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify site of ulcer (L97.4-, L97.5-)
- code to identify control using:Inherited from E11
- injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E11
- insulin (Z79.4)Inherited from E11
- oral antidiabetic drugs (Z79.84)Inherited from E11
- oral hypoglycemic drugs (Z79.84)Inherited from E11
Code Also
OfficialNo Code Also instructions are included in this display for E11.621. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E11.621 an HCC code?
Yes. E11.621 (Type 2 diabetes mellitus with foot ulcer) maps to HCC 37, Diabetes with Chronic Complications and HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model, with source-labeled community non-dual aged reference coefficients HCC 37 0.166 and HCC 383 0.646. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: E11.621 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications and HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.621
- Description
- Type 2 diabetes mellitus with foot ulcer
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications; HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
- RAF reference coefficient
- HCC 37: 0.166; HCC 383: 0.646
- 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 E11.621 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E11.621
For E11.621, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
E11.621 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with foot ulcer. Type 2 diabetes resulting in an open sore or wound on the foot that fails to heal properly. E11.621 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, E11.621 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E11.621; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
The documentation must describe a current foot ulcer in a patient with diabetes. Site and severity detail belongs in an L97.4x or L97.5x code reported additionally; E11.621 alone does not capture laterality or stage. For E11.621, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for E11.621 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The documentation must describe a current foot ulcer in a patient with diabetes. Site and severity detail belongs in an L97.4x or L97.5x code reported additionally; E11.621 alone does not capture laterality or stage.
- •Always pair E11.621 with the appropriate L97.4x or L97.5x code for the ulcer site and severity. Coding E11.621 without the ulcer-detail code is an incomplete code assignment per ICD-10-CM guidelines.
- •The official CY2026 final mapping lists V28 HCC 37 and HCC 383 for E11.621. Pair it with the supported L97.4x or L97.5x detail code, then resolve hierarchy and member-segment coefficients from the complete diagnosis set.
Clinical Significance
Type 2 diabetes mellitus with foot ulcer is one of the most clinically significant diabetic complications, representing the primary pathway to non-traumatic lower extremity amputation. Diabetic foot ulcers develop from the convergence of peripheral neuropathy (loss of protective sensation), peripheral arterial disease (impaired blood flow), and foot deformity (abnormal pressure distribution). Annual incidence in diabetic patients is 2-5%, with lifetime risk as high as 25%.
Documentation Requirements
- ✓Documentation must specify a foot ulcer in a Type 2 diabetic patient, including precise anatomical location (heel, midfoot, forefoot, toe), ulcer dimensions, depth classification (Wagner grade or University of Texas classification), and presence of infection or exposed structures.
- ✓An additional L97 code must be assigned for ulcer site and severity specificity.
- ✓Vascular assessment, neuropathy evaluation, and wound care plan should be documented.
Commonly Confused Codes
- •E11.622 (other skin ulcer) is for non-pedal ulcer locations.
- •E11.52 (peripheral angiopathy with gangrene) indicates tissue death beyond ulceration.
- •L97.4-L97.5 (non-pressure chronic ulcer of foot) are required additional codes for site specificity.
- •E11.620 (diabetic dermatitis) covers inflammatory skin conditions without ulceration.