E13.641 ICD-10-CM Code: Other specified diabetes mellitus with hypoglycemia with coma
E13.641 maps to CMS-HCC V28 36. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E13.641
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified diabetes mellitus with hypoglycemia with coma
This code describes a serious condition where a patient with a specific type of diabetes (not Type 1 or Type 2) experiences dangerously low blood sugar levels that cause them to lose consciousness. This is a medical emergency requiring immediate treatment to restore blood sugar levels.
Buddy Insight
E13.
CMS-HCC V28
MappedHCC 36
Coefficient HCC 36: 0.166 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 019
Code-level coefficient reference
ESRD/PACE
MappedHCC 17
Code-level coefficient reference
RXHCC
MappedHCC 30
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for E13.641. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E13.641. Check the code and parent instructions in the Code Book.
Related Codes
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
OfficialNo Code First sequencing instructions are included in this display for E13.641. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify control using:Inherited from E13, E13.64
- injectable non-insulin antidiabetic drugs (Z79.85)Inherited from E13, E13.64
- insulin (Z79.4)Inherited from E13, E13.64
- oral antidiabetic drugs (Z79.84)Inherited from E13, E13.64
- oral hypoglycemic drugs (Z79.84)Inherited from E13, E13.64
- code for hypoglycemia level, if applicable (E16.A-)Inherited from E13, E13.64
Code Also
OfficialNo Code Also instructions are included in this display for E13.641. Check the code and parent instructions in the Code Book.
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 E13.641 an HCC code?
Yes. E13.641 (Other specified diabetes mellitus with hypoglycemia with coma) maps to HCC 36, Diabetes with Severe Acute 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: E13.641 is billable and maps to V28 HCC 36, Diabetes with Severe Acute Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- E13.641
- Description
- Other specified diabetes mellitus with hypoglycemia with coma
- HCC (V28)
- HCC 36 — Diabetes with Severe Acute Complications
- RAF reference coefficient
- 0.166
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 E13.641 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E13.641
For E13.641, 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
E13.641 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with hypoglycemia with coma. This code describes a serious condition where a patient with a specific type of diabetes (not Type 1 or Type 2) experiences dangerously low blood sugar levels that cause them to lose consciousness. This is a medical emergency requiring immediate treatment to restore blood sugar levels. E13.641 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, E13.641 maps to Diabetes with Severe Acute Complications (HCC 36) with a source-labeled community, non-dual, aged reference coefficient of 0.166. 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.
Verify the diabetes type is documented as 'other specified' rather than Type 1 or Type 2, as this distinction is critical for correct code selection. For E13.641, 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 E13.641 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the diabetes type is documented as 'other specified' rather than Type 1 or Type 2, as this distinction is critical for correct code selection
- •Ensure documentation clearly indicates both hypoglycemia AND coma are present; if only hypoglycemia without coma exists, use E13.641 without the coma component instead
Clinical Significance
E13.641 identifies hypoglycemia with coma in other specified diabetes mellitus, representing a severe and potentially fatal acute complication. Hypoglycemic coma occurs when blood glucose drops critically low (typically below 40 mg/dL), causing loss of consciousness due to neuroglycopenia. This requires immediate glucose administration and is most commonly associated with insulin or sulfonylurea therapy.
Documentation Requirements
- ✓Documentation must confirm secondary diabetes, hypoglycemia with coma, and the clinical circumstances.
- ✓Blood glucose levels, the cause of hypoglycemia (medication-related, missed meals, excessive exercise), treatment administered, and resolution of coma should be documented.