E11.628
BillableType 2 diabetes mellitus with other skin complications
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.628 an HCC code?
Yes. E11.628 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 E11.628
For E11.628 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 E11.628 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.628 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with other skin complications. Type 2 diabetes causing various skin problems not specifically classified elsewhere, such as necrobiosis or diabetic bullae. E11.628 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, E11.628 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, E11.628 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.
Use this code only when the specific skin complication doesn't fit other more specific diabetic skin codes. Because E11.628 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 E11.628 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific skin complication doesn't fit other more specific diabetic skin codes
- •Document the exact nature of the skin complication for clarity and medical necessity
Clinical Significance
Type 2 diabetes mellitus with other skin complications captures a range of diabetes-related skin conditions beyond dermatitis and ulceration, including necrobiosis lipoidica, diabetic bullae (blisters), scleroderma diabeticorum, eruptive xanthomas, acanthosis nigricans, and diabetic thick skin. These conditions serve as clinical markers of metabolic derangement and may indicate the need for more aggressive glycemic management.
Documentation Requirements
- ✓The provider must document the specific skin complication and establish its causal relationship to Type 2 diabetes.
- ✓Description of the appearance, location, extent, and any treatment should be recorded.
- ✓The documentation must confirm the condition is not dermatitis (E11.620) or ulceration (E11.621/E11.622), which have their own specific codes.
- ✓Dermatological consultation findings strengthen documentation.