E11.9 ICD-10-CM Code: Type 2 diabetes mellitus without complications

Code

E11.9

Description

Type 2 diabetes mellitus without complications

HCC (V28)

HCC 38 — Diabetes with No, Glycemic, or Unspecified Complications

RAF reference coefficient

0.166

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E11.9 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E11.9

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E11.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •For E11.9, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
• •Do not default to E11.9 when the chart supports a more specific code. E11.21 and E11.40 map to HCC 37. E11.311 has two official CY2026 V28 mapping rows, HCC 37 and HCC 298.
• •Under V28, HCC 37 and HCC 38 carry the same community coefficient (0.166), so moving E11.9 to a chronic-complication child code does not raise the diabetes weight by itself. The payoff is chart accuracy and the additional HCCs a fuller picture captures, for example the paired N18 CKD code or a separate complication HCC, not a bigger diabetes coefficient.

Clinical Significance

E11.9 identifies type 2 diabetes mellitus managed without any documented complications. This is the most commonly reported diabetes code and represents the baseline diabetic condition requiring ongoing monitoring, medication management, and lifestyle modifications to prevent progression to complications.

Documentation Requirements

• ✓The provider must document the diagnosis of type 2 diabetes.
• ✓The absence of complications should be implicit or explicitly stated.
• ✓If any complications exist but are not documented, coders should query the provider to ensure complete and accurate code assignment.

Commonly Confused Codes

• •E11.65 (type 2 diabetes with hyperglycemia) when uncontrolled blood sugar is documented
• •E11.8 (unspecified complications) when vague complication language is present
• •E13.9 (other specified diabetes without complications) when the diabetes type is secondary rather than type 2.

Child Codes