E13.10
BillableOther specified diabetes mellitus with ketoacidosis without coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.10 an HCC code?
Yes. E13.10 maps to Diabetes with Severe 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 E13.10
For E13.10to 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 E13.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.10 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with ketoacidosis without coma. This code describes a type of diabetes (other than Type 1 or Type 2) where the body produces dangerous acids in the blood due to improper insulin use or management, but the patient is still conscious and alert. This is a serious metabolic emergency that requires immediate medical attention. E13.10 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, E13.10 maps to Diabetes with Severe Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.166. Under the older CMS-HCC V24 model, E13.10 maps to Diabetes with Acute Complications (HCC 17) 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 the diabetes type is documented as 'other specified' rather than Type 1 (E10) or Type 2 (E11) to ensure correct code selection. Because E13.10 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 E13.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
E13.10 captures diabetic ketoacidosis in other specified (secondary) diabetes without progression to coma. Diabetic ketoacidosis is characterized by hyperglycemia, metabolic acidosis, and ketonemia, representing a serious acute metabolic decompensation that requires emergent medical intervention with insulin, fluids, and electrolyte management.
Documentation Requirements
- ✓Documentation must confirm the diabetes is secondary/other specified (not type 1 or type 2) and that ketoacidosis is present.
- ✓Supporting lab findings should include elevated blood glucose, low serum bicarbonate or pH, and positive ketones.
- ✓The provider must confirm the patient is not in coma.