What is ICD-10 code E13.630?

E13.630 is the ICD-10-CM diagnosis code for Other specified diabetes mellitus with periodontal disease. A type of diabetes (not type 1 or type 2) that causes gum disease and tooth-supporting tissue damage. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E13.630 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E13.630 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E13.630 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E13.630 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E13.630 map to under V28?

E13.630 maps to CMS-HCC V28 HCC 37 (Diabetes with Chronic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM E13.630: Other specified diabetes

E13.630 maps to CMS-HCC V28 37. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupE13.630

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)

E13.630

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other specified diabetes mellitus with periodontal disease

A type of diabetes (not type 1 or type 2) that causes gum disease and tooth-supporting tissue damage.

Buddy Insight

E13.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 37

Diabetes with Chronic Complic...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 020

HHS-HCC 020 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 18

Diabetes with Chronic Complic...

Code-level coefficient reference

RXHCC

Mapped

HCC 30

Diabetes with Complications

Code-level coefficient reference

Code Book Path

Official

E13.6Other specified diabetes mellitus with other specified complications E13.63Other specified diabetes mellitus with oral complications E13.630Other specified diabetes mellitus with periodontal disease

Inclusion Terms

Official

No inclusion terms are included in this display for E13.630. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for E13.630. Check the code and parent instructions in the Code Book.

Related Codes

Official

E13.638Other specified diabetes mellitus with other oral complications

Includes

Official

diabetes mellitus due to genetic defects of beta-cell functionInherited from E13
diabetes mellitus due to genetic defects in insulin actionInherited from E13
postpancreatectomy diabetes mellitusInherited from E13
postprocedural diabetes mellitusInherited from E13
secondary diabetes mellitus NECInherited from E13

Excludes 1

Official

transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E13
diabetes (mellitus) due to autoimmune process (E10.-)Inherited from E00-E89, E13
diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)Inherited from E00-E89, E13
diabetes mellitus due to underlying condition (E08.-)Inherited from E00-E89, E13
drug or chemical induced diabetes mellitus (E09.-)Inherited from E00-E89, E13
gestational diabetes (O24.4-)Inherited from E00-E89, E13
neonatal diabetes mellitus (P70.2)Inherited from E00-E89, E13
type 1 diabetes mellitus (E10.-)Inherited from E00-E89, E13

Code First

Official

No Code First sequencing instructions are included in this display for E13.630. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify control using:Inherited from E13
injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E13
insulin (Z79.4)Inherited from E13
oral antidiabetic drugs (Z79.84)Inherited from E13
oral hypoglycemic drugs (Z79.84)Inherited from E13

Code Also

Official

No Code Also instructions are included in this display for E13.630. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

The provider must document secondary diabetes and periodontal disease with a causal link to diabetes.

Dental or periodontal examination findings including pocket depths, bone loss, and gingival inflammation should be documented.

The bidirectional nature makes establishing causality important.

MEAT Support

HCC Buddy guidance

The provider must document secondary diabetes and periodontal disease with a causal link to diabetes.

Dental or periodontal examination findings including pocket depths, bone loss, and gingival inflammation should be documented.

The bidirectional nature makes establishing causality important.

Audit Caution

HCC Buddy guidance

Periodontal disease is very common in the general population, so documentation must establish the diabetes connection rather than simply coding incidental dental disease.

Not all gum disease in diabetic patients is diabetic periodontal disease.

Common Mistakes

HCC Buddy guidance

E13.638 (other oral complications) for non-periodontal oral manifestations

K05.x (gingivitis and periodontal disease) codes which may be used additionally for specificity

E11.630 (type 2 diabetes with periodontal disease) when diabetes is type 2.

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 E13.630 an HCC code?

Yes. E13.630 (Other specified diabetes mellitus with periodontal disease) maps to HCC 37, Diabetes with Chronic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.166. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: E13.630 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: E13.630
Description: Other specified diabetes mellitus with periodontal disease
HCC (V28): HCC 37 — Diabetes with Chronic Complications
RAF reference coefficient: 0.166
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 37, Diabetes with Chronic Complications

0.166

ESRDHCC 18, Diabetes with Chronic Complications

Not separately weighted

RxHCCHCC 30, Diabetes with Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E13.630 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E13.630

For E13.630, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

E13.630 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with periodontal disease. A type of diabetes (not type 1 or type 2) that causes gum disease and tooth-supporting tissue damage. E13.630 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, E13.630 maps to Diabetes with Chronic Complications (HCC 37) with a source-labeled community, non-dual, aged reference coefficient of 0.166. No V24 mapping is shown for E13.630; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document the severity of periodontal disease (gingivitis vs. periodontitis). For E13.630, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for E13.630 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the severity of periodontal disease (gingivitis vs. periodontitis)
•Coordinate with dental records if available for complete documentation

Clinical Significance

E13.630 identifies periodontal disease in other specified diabetes mellitus. Diabetes significantly increases the risk and severity of periodontal disease through impaired immune function, altered collagen metabolism, and microvascular changes in gingival tissues. The relationship is bidirectional, as periodontal disease can worsen glycemic control.

Documentation Requirements

✓The provider must document secondary diabetes and periodontal disease with a causal link to diabetes.
✓Dental or periodontal examination findings including pocket depths, bone loss, and gingival inflammation should be documented.
✓The bidirectional nature makes establishing causality important.

Commonly Confused Codes

•E13.638 (other oral complications) for non-periodontal oral manifestations
•K05.x (gingivitis and periodontal disease) codes which may be used additionally for specificity
•E11.630 (type 2 diabetes with periodontal disease) when diabetes is type 2.