E13.00
BillableOther specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.00 an HCC code?
Yes. E13.00 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 E13.00
For E13.00 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 E13.00 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.00 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (nkhhc). A secondary form of diabetes with dangerously high blood sugar and blood thickness, but without a life-threatening coma. E13.00 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, E13.00 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, E13.00 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.
E13 is used for diabetes caused by other specific conditions (pancreatitis, cystic fibrosis, hemochromatosis, etc.); document the underlying cause. Because E13.00 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 E13.00 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •E13 is used for diabetes caused by other specific conditions (pancreatitis, cystic fibrosis, hemochromatosis, etc.); document the underlying cause
- •The fifth character distinguishes between with and without coma; verify coma status in documentation
Clinical Significance
E13.00 identifies other specified diabetes mellitus (secondary diabetes) presenting with hyperosmolarity but without progression to nonketotic hyperglycemic-hyperosmolar coma. Hyperosmolar hyperglycemic state is a life-threatening emergency characterized by extreme hyperglycemia, dehydration, and high serum osmolality, typically seen in patients with residual insulin secretion.
Documentation Requirements
- ✓Documentation must identify the diabetes as secondary (due to a known underlying cause such as pancreatitis, cystic fibrosis, or drug-induced) and confirm the presence of hyperosmolarity.
- ✓Lab values including serum glucose, osmolality, and absence of significant ketosis should support the diagnosis.
- ✓Coma status must be explicitly addressed.
Commonly Confused Codes
- •E13.01 (with coma) when the patient progresses to altered consciousness
- •E11.00 (type 2 diabetes with hyperosmolarity without coma) when the diabetes type is type 2 rather than secondary
- •E13.10 (ketoacidosis without coma) when acidosis rather than hyperosmolarity is the primary metabolic derangement.