E13.610
BillableOther specified diabetes mellitus with diabetic neuropathic arthropathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.610 an HCC code?
Yes. E13.610 maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic 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 E13.610
For E13.610 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 E13.610 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.610 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with diabetic neuropathic arthropathy. A type of diabetes (not type 1 or type 2) that causes joint damage and arthritis due to nerve damage from high blood sugar. E13.610 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, E13.610 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E13.610 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.
This code requires documentation of both the diabetes type (other specified) and the neuropathic arthropathy complication. Because E13.610 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 E13.610 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires documentation of both the diabetes type (other specified) and the neuropathic arthropathy complication
- •Verify the specific joint affected is documented; additional codes may be needed to specify location
Clinical Significance
E13.610 identifies diabetic neuropathic arthropathy (Charcot joint) in other specified diabetes mellitus. Charcot neuroarthropathy is a progressive, destructive joint condition resulting from severe peripheral neuropathy that eliminates protective pain sensation, leading to unrecognized repetitive trauma, joint destruction, deformity, and potential limb loss, most commonly affecting the foot and ankle.
Documentation Requirements
- ✓Documentation must confirm secondary diabetes, neuropathic arthropathy diagnosis, and the affected joint(s).
- ✓Imaging findings showing joint destruction, fractures, dislocations, or bone remodeling should be referenced.
- ✓The link between diabetic neuropathy and the joint disease must be established.