E11.649
BillableType 2 diabetes mellitus with hypoglycemia without coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E11.649 an HCC code?
Yes. E11.649 maps to Diabetes without Complication 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 E11.649
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.
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 without Complication (HCC 38) with a community, non-dual, aged base RAF weight of 0.450. 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.