E11.65 ICD-10-CM Code: Type 2 diabetes mellitus with hyperglycemia
E11.65 maps to CMS-HCC V28 38 (RAF 0.166). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.65
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with hyperglycemia
Type 2 diabetes with abnormally high blood sugar levels that are not controlled by current treatment.
Buddy Insight
Type 2 diabetes mellitus with hyperglycemia indicates persistently elevated blood glucose that is inadequately controlled by current therapy, including oral medications, non-insulin injectables, or insulin.
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 E11.65 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.65 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.65 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.65 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.65 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.65 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.65 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 E11.65 an HCC code?
Yes. E11.65 (Type 2 diabetes mellitus with hyperglycemia) 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: E11.65 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
- E11.65
- Description
- Type 2 diabetes mellitus with hyperglycemia
- 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 E11.65 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E11.65
For E11.65 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 E11.65 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E11.65 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with hyperglycemia. Type 2 diabetes with abnormally high blood sugar levels that are not controlled by current treatment. E11.65 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, E11.65 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, E11.65 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.
The provider note must document hyperglycemia as a current finding for this encounter, not just an elevated A1C in lab data. A statement like 'type 2 diabetes, uncontrolled' or 'hyperglycemia, increased insulin' satisfies the hyperglycemia criterion; a standalone lab value without provider interpretation does not. Because E11.65 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 E11.65 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The provider note must document hyperglycemia as a current finding for this encounter, not just an elevated A1C in lab data. A statement like 'type 2 diabetes, uncontrolled' or 'hyperglycemia, increased insulin' satisfies the hyperglycemia criterion; a standalone lab value without provider interpretation does not.
- •E11.65 is not a chronic-complication code, it maps to HCC 38, not HCC 37. Coders sometimes overweight the 'with hyperglycemia' specificity and assume a higher-tier HCC; the V28 model treats it the same as E11.9 for risk adjustment purposes.
- •V28 HCC 38 at RAF 0.166. If the chart also supports CKD, neuropathy, retinopathy, or peripheral angiopathy, a combination code in the E11.2x/E11.3x/E11.4x/E11.5x range captures HCC 37 instead.
Clinical Significance
Type 2 diabetes mellitus with hyperglycemia indicates persistently elevated blood glucose that is inadequately controlled by current therapy, including oral medications, non-insulin injectables, or insulin. Chronic hyperglycemia drives the development and progression of all microvascular and macrovascular diabetic complications. This code signals the need for treatment intensification through medication adjustment, lifestyle modification, or specialist referral.
Documentation Requirements
- ✓The provider must document hyperglycemia in the context of Type 2 diabetes, including specific blood glucose readings or hemoglobin A1c values demonstrating inadequate control.
- ✓Current medication regimen, adherence assessment, and planned therapeutic changes should be recorded.
- ✓The documentation should distinguish hyperglycemia from diabetic ketoacidosis or hyperosmolar state, which are more severe conditions.
Commonly Confused Codes
- •E11.00/E11.01 (hyperosmolarity) and E11.10/E11.11 (ketoacidosis) represent more severe metabolic decompensation and should be used when those criteria are met.
- •E11.9 (without complications) is used when no complications including hyperglycemia are documented.
- •E11.649 (hypoglycemia) is the opposite metabolic derangement.
- •Z79.84 (long-term use of oral hypoglycemic drugs) is a status code, not a complication code.