E13.52
BillableOther specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.52 an HCC code?
No. E13.52 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 E13.52
For E13.52 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 E13.52 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.52 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene. A type of diabetes (not type 1 or type 2) causing poor blood circulation in the legs and feet that has resulted in tissue death or gangrene. E13.52 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
E13.52 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code has no V28 or V24 HCC mapping in the provided data, which may reflect model-specific exclusions or payment bundling. However, the clinical severity warrants thorough documentation for any applicable supplemental risk models or quality metrics. Coders reviewing E13.52 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC — capturing the correct specificity is the highest-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E13.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm gangrene is documented; this is a more severe condition than E13.51
- •Document the extent and location of gangrene for treatment planning
Clinical Significance
E13.52 represents the most severe vascular complication of other specified diabetes mellitus, with peripheral angiopathy progressing to gangrene. Diabetic gangrene indicates tissue death due to inadequate blood supply and often requires surgical intervention including debridement or amputation. This condition carries significant morbidity, mortality, and resource utilization.
Documentation Requirements
- ✓Documentation must confirm secondary diabetes, peripheral vascular disease with gangrene, and the diabetic etiology.
- ✓The location and extent of gangrene must be specified.
- ✓Wound care documentation, vascular surgery notes, and amputation records if applicable should be present.