E13.628 ICD-10-CM Code: Other specified diabetes mellitus with other skin complications
HCC Buddy Code Card
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E13.628
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified diabetes mellitus with other skin complications
This code describes a type of diabetes (not type 1 or type 2) that is causing skin problems beyond the common diabetic complications. These skin issues could include infections, ulcers, or other conditions directly related to the diabetes.
Buddy Insight
E13.
CMS-HCC V28
MappedHCC 37
RAF 0.166
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
MappedHCC 20
Varies by metal level
ESRD/PACE
MappedHCC 18
RAF 0.084
RXHCC
MappedHCC 30
RAF 0.495
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E13.628 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E13.628 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E13.628 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E13.628 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E13.628 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E13.628 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E13.628 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E13.628 an HCC code?
Yes. E13.628 (Other specified diabetes mellitus with other skin complications) maps to Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Chronic Complications under V24), with a community non-dual aged RAF of 0.166. It is billable for payment year 2026.
Coder answer: E13.628 is billable and maps to V28 HCC 37, Diabetes with Chronic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E13.628
- Description
- Other specified diabetes mellitus with other skin complications
- HCC (V28)
- HCC 37 — Diabetes with Chronic Complications
- RAF
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work E13.628 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E13.628
For E13.628 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 E13.628 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E13.628 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with other skin complications. This code describes a type of diabetes (not type 1 or type 2) that is causing skin problems beyond the common diabetic complications. These skin issues could include infections, ulcers, or other conditions directly related to the diabetes. E13.628 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, E13.628 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.166. Under the older V24 model, E13.628 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.
Ensure the documentation specifies 'other specified diabetes mellitus' rather than type 1 or type 2 diabetes, and clearly identifies the specific skin complication present. Because E13.628 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 E13.628 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure the documentation specifies 'other specified diabetes mellitus' rather than type 1 or type 2 diabetes, and clearly identifies the specific skin complication present
- •The fifth character '2' indicates 'with complications' and the sixth character '8' specifies 'other skin complications' - verify the skin condition is documented and related to the diabetes before assigning this code
Clinical Significance
E13.628 captures other skin complications of other specified diabetes mellitus beyond dermatitis and ulcers. These include conditions such as diabetic thick skin (scleredema diabeticorum), acanthosis nigricans associated with insulin resistance, granuloma annulare, or other dermatologic manifestations directly attributable to the metabolic dysfunction of secondary diabetes.
Documentation Requirements
- ✓The provider must document the secondary diabetes, the specific skin complication, and its causal relationship to diabetes.
- ✓The condition must not fit into the dermatitis (E13.620) or ulcer (E13.621/E13.622) subcategories.
- ✓Dermatologic examination and clinical description should support the diagnosis.