E13.65 ICD-10-CM Code: Other specified diabetes mellitus with hyperglycemia
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E13.65
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified diabetes mellitus with hyperglycemia
A type of diabetes (not type 1 or type 2) with abnormally high blood sugar levels.
Buddy Insight
E13.
CMS-HCC V28
MappedHCC 38
RAF 0.450
CMS-HCC V24
MappedHCC 18
RAF 0.302
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 18
RAF 0.0
RXHCC
MappedHCC 30
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E13.65 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E13.65 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E13.65 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E13.65 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E13.65 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E13.65 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E13.65 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is E13.65 an HCC code?
Yes. E13.65 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 E13.65
For E13.65to 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 E13.65 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
E13.65 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with hyperglycemia. A type of diabetes (not type 1 or type 2) with abnormally high blood sugar levels. E13.65 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, E13.65 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, E13.65 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.
This code indicates elevated blood glucose; document the specific glucose level if available. Because E13.65 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 E13.65 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates elevated blood glucose; document the specific glucose level if available
- •Distinguish between hyperglycemia with or without ketoacidosis
Clinical Significance
E13.65 identifies hyperglycemia in other specified diabetes mellitus, indicating that the patient's blood glucose is not adequately controlled. Persistent hyperglycemia accelerates microvascular and macrovascular complications, increasing the risk of nephropathy, retinopathy, neuropathy, and cardiovascular disease in patients with secondary diabetes.
Documentation Requirements
- ✓Documentation must confirm secondary diabetes with hyperglycemia.
- ✓Elevated blood glucose levels, hemoglobin A1c values, and the clinical context (medication non-adherence, illness, steroid use) should be documented.
- ✓The provider should describe the treatment plan for addressing the hyperglycemia.