E11.630
BillableType 2 diabetes mellitus with periodontal disease
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.630 an HCC code?
Yes. E11.630 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 E11.630
For E11.630 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 E11.630 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.630 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with periodontal disease. Type 2 diabetes causing gum disease and deterioration of the structures supporting the teeth. E11.630 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, E11.630 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, E11.630 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.
Confirm periodontal disease diagnosis is documented by dental or medical provider. Because E11.630 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 E11.630 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm periodontal disease diagnosis is documented by dental or medical provider
- •Note that this code captures the diabetes-periodontal disease relationship for comprehensive care coordination
Clinical Significance
Type 2 diabetes mellitus with periodontal disease documents the well-established bidirectional relationship between diabetes and periodontal health. Hyperglycemia promotes bacterial growth, impairs immune response, and compromises gingival blood flow, leading to accelerated periodontal tissue destruction. Conversely, the chronic inflammatory state of periodontitis worsens insulin resistance and glycemic control, creating a cycle that amplifies both conditions.
Documentation Requirements
- ✓Documentation must establish periodontal disease as a complication of Type 2 diabetes rather than merely a coexisting condition.
- ✓Dental or periodontal examination findings, gum disease classification (gingivitis versus periodontitis and severity), and treatment referrals should be recorded.
- ✓The bidirectional impact on glycemic control should be noted in the management plan.