E13.641
BillableOther specified diabetes mellitus with hypoglycemia with coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.641 an HCC code?
Yes. E13.641 maps to Diabetes with Acute Complications under the CMS-HCC V28 risk adjustment model (and Diabetes with Acute 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 E13.641
For E13.641 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 E13.641 during that encounter — not just copy-forwarded from a problem list.
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 Acute Complications (HCC 36) with a community, non-dual, aged base RAF weight of 0.390. Under the older V24 model, E13.641 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.
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. Because E13.641 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 E13.641 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.