E11.641
BillableType 2 diabetes mellitus with hypoglycemia with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.641 an HCC code?
Yes. E11.641 maps to Diabetes with Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute 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 E11.641
For E11.641 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 E11.641 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E11.641 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with hypoglycemia with coma. Type 2 diabetes causing dangerously low blood sugar levels that result in loss of consciousness or coma. E11.641 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, E11.641 maps to Diabetes with Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.390. Under the older V24 model, E11.641 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.
This is a medical emergency; ensure documentation clearly indicates hypoglycemic coma occurred. Because E11.641 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 E11.641 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a medical emergency; ensure documentation clearly indicates hypoglycemic coma occurred
- •Verify the hypoglycemia was confirmed by blood glucose measurement when possible
Clinical Significance
Type 2 diabetes mellitus with hypoglycemia with coma is a life-threatening acute complication more commonly seen in elderly patients on sulfonylureas or insulin therapy. Hypoglycemic coma in Type 2 diabetes may be prolonged and more difficult to reverse than in Type 1 due to longer-acting oral medications and impaired counter-regulatory hormonal responses. This condition carries significant mortality and morbidity risk, including permanent neurological damage from prolonged cerebral glucose deprivation.
Documentation Requirements
- ✓Documentation must clearly state hypoglycemic coma occurred in a Type 2 diabetic patient, including blood glucose levels, duration of unconsciousness, precipitating medication(s), treatment administered, and neurological recovery.
- ✓The specific diabetes medication causing hypoglycemia should be identified when possible.
- ✓Emergency department or hospital records should include Glasgow Coma Scale scores and monitoring documentation.