E13.69
BillableOther specified diabetes mellitus with other specified complication
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E13.69 an HCC code?
Yes. E13.69 maps to Diabetes with Chronic Complications 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 E13.69
For E13.69 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 E13.69 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E13.69 is the ICD-10-CM diagnosis code for other specified diabetes mellitus with other specified complication. A type of diabetes (not type 1 or type 2) with a complication not listed in other specific codes. E13.69 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, E13.69 maps to Diabetes with Chronic Complications (HCC 37) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, E13.69 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.
Use this code only when the diabetic complication does not fit into other E13 subcategories. Because E13.69 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 E13.69 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the diabetic complication does not fit into other E13 subcategories
- •Provide detailed documentation of the specific complication for clarity
Clinical Significance
E13.69 captures other specified complications of other specified diabetes mellitus, serving as a category for diabetic complications that do not fit into the standard subcategories of renal, ophthalmic, neurological, vascular, or skin complications. These may include diabetic myonecrosis, diabetic cheiroarthropathy, or other rare systemic manifestations of secondary diabetes.
Documentation Requirements
- ✓The provider must document secondary diabetes, the specific complication, and its causal relationship to diabetes.
- ✓The complication must not be classifiable under more specific E13 subcategories.
- ✓Clear clinical description of the complication and supporting evidence should be present.
Use Additional Code
- code to identify complication