E11.649 ICD-10-CM Code: Type 2 diabetes mellitus with hypoglycemia without coma
E11.649 maps to CMS-HCC V28 38 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.649
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with hypoglycemia without coma
This code describes a patient with type 2 diabetes who is experiencing low blood sugar (hypoglycemia) but is still conscious and alert. Hypoglycemia is a dangerous condition where blood glucose drops too low, causing symptoms like shakiness, sweating, and confusion.
Buddy Insight
Type 2 diabetes mellitus with hypoglycemia without coma is a common acute complication that can occur with insulin therapy, sulfonylureas, or meglitinides.
CMS-HCC V28
MappedHCC 38
RAF 0.166
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
MappedHCC 21
Varies by metal level
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.649 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.649 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.649 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.649 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.649 in this effective period.
Use Additional
Official- code for hypoglycemia level, if applicable (E16.A-)
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.649 in this effective period.
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 E11.649 an HCC code?
Yes. E11.649 (Type 2 diabetes mellitus with hypoglycemia without coma) maps to Diabetes with No, Glycemic, or Unspecified Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E11.649 is billable and maps to V28 HCC 38, Diabetes with No, Glycemic, or Unspecified Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E11.649
- Description
- Type 2 diabetes mellitus with hypoglycemia without coma
- HCC (V28)
- HCC 38 — Diabetes with No, Glycemic, or Unspecified Complications
- RAF
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work E11.649 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E11.649
For E11.649 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 E11.649 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E11.649 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with hypoglycemia without coma. This code describes a patient with type 2 diabetes who is experiencing low blood sugar (hypoglycemia) but is still conscious and alert. Hypoglycemia is a dangerous condition where blood glucose drops too low, causing symptoms like shakiness, sweating, and confusion. E11.649 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, E11.649 maps to Diabetes with No, Glycemic, or Unspecified Complications (HCC 38) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E11.649 maps to Diabetes with Chronic Complications (HCC 18) with a community, non-dual, aged base RAF weight of 0.302. 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.
Verify documentation clearly states both type 2 diabetes AND hypoglycemia without coma; do not assume hypoglycemia is present without explicit provider documentation. Because E11.649 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 E11.649 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly states both type 2 diabetes AND hypoglycemia without coma; do not assume hypoglycemia is present without explicit provider documentation
- •The .649 extension specifically indicates hypoglycemia without loss of consciousness; if the patient lost consciousness or had a hypoglycemic coma, use E11.641 instead
Clinical Significance
Type 2 diabetes mellitus with hypoglycemia without coma is a common acute complication that can occur with insulin therapy, sulfonylureas, or meglitinides. Episodes range from mild (self-treated with oral glucose) to severe (requiring assistance but without loss of consciousness). Recurrent hypoglycemia may lead to hypoglycemia unawareness, where patients lose the ability to detect early warning symptoms, dramatically increasing the risk for severe episodes and falls.
Documentation Requirements
- ✓The medical record must document a hypoglycemic episode in a Type 2 diabetic patient with confirmation that coma did not occur.
- ✓Blood glucose readings, symptoms experienced, precipitating medications, and treatment provided should be recorded.
- ✓Frequency of episodes, medication adjustments made, and patient education regarding hypoglycemia recognition and management should be documented.
Commonly Confused Codes
- •E11.641 (hypoglycemia with coma) is used when loss of consciousness occurs and maps to a higher HCC tier in some models.
- •E11.65 (hyperglycemia) is the opposite metabolic derangement with high blood sugar.
- •E16.0 (drug-induced hypoglycemia without coma) is for non-diabetic medication-induced low blood sugar.
- •E16.2 (hypoglycemia, unspecified) does not capture the diabetic context.