E13.649
BillableOther specified diabetes mellitus with hypoglycemia without coma
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.649 an HCC code?
Yes. E13.649 maps to Diabetes without Complication 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 E13.649
For E13.649 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 E13.649 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.649 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with hypoglycemia without coma. A type of diabetes (not type 1 or type 2) with low blood sugar that does not cause loss of consciousness. E13.649 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, E13.649 maps to Diabetes without Complication (HCC 38) with a community, non-dual, aged base RAF weight of 0.450. Under the older CMS-HCC V24 model, E13.649 maps to Diabetes with Chronic Complications (HCC 18) with a community, non-dual, aged base RAF weight of 0.302. 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 that hypoglycemia is present but the patient did not lose consciousness; if coma occurred, use E13.641 instead. Because E13.649 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 E13.649 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that hypoglycemia is present but the patient did not lose consciousness; if coma occurred, use E13.641 instead
- •Document the severity and symptoms of the hypoglycemic episode
Clinical Significance
E13.649 captures hypoglycemia without coma in other specified diabetes mellitus. Hypoglycemic episodes, while not resulting in loss of consciousness, can cause significant symptoms including confusion, diaphoresis, tremors, palpitations, and seizures. Recurrent hypoglycemia may lead to hypoglycemia unawareness, paradoxically increasing the risk of severe future episodes.
Documentation Requirements
- ✓The provider must document secondary diabetes, the hypoglycemic episode, and confirm that coma did not occur.
- ✓Blood glucose levels, symptoms, precipitating factors, treatment, and any medication adjustments should be recorded.