E24.4 ICD-10-CM Code: Alcohol-induced pseudo-Cushing's syndrome
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of other endocrine glands (E20-E35)
E24.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAlcohol-induced pseudo-Cushing's syndrome
A condition that mimics Cushing's syndrome in people with heavy alcohol use, where cortisol levels appear elevated but resolve with abstinence from alcohol.
Buddy Insight
Alcohol-induced pseudo-Cushing syndrome mimics true Cushing syndrome biochemically with elevated cortisol levels in patients with chronic heavy alcohol use.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
MappedHCC 23
RAF 0.230
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 23
RAF 0.0
RXHCC
MappedHCC 43
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E24.4 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E24.4 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E24.4 in this effective period.
Excludes 1
Official- congenital adrenal hyperplasia (E25.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E24.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E24.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E24.4 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 E24.4 an HCC code?
Yes. E24.4 maps to Other Significant Endocrine and Metabolic Disorders under the V24 model but is not retained in V28.
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.
Work E24.4 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E24.4
For E24.4to 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 E24.4 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E24.4 is the ICD-10-CM diagnosis code for alcohol-induced pseudo-cushing's syndrome. A condition that mimics Cushing's syndrome in people with heavy alcohol use, where cortisol levels appear elevated but resolve with abstinence from alcohol. E24.4 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of other endocrine glands (e20-e35).
Under the older CMS-HCC V24 model, E24.4 maps to Other Significant Endocrine and Metabolic Disorders (HCC 23) with a community, non-dual, aged base RAF weight of 0.230. 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.
Document alcohol use disorder in conjunction with this code. Because E24.4 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 E24.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document alcohol use disorder in conjunction with this code
- •This is a pseudo-Cushing's state; distinguish from true Cushing's syndrome in the clinical assessment
Clinical Significance
Alcohol-induced pseudo-Cushing syndrome mimics true Cushing syndrome biochemically with elevated cortisol levels in patients with chronic heavy alcohol use. Unlike true Cushing syndrome, the hypothalamic-pituitary-adrenal axis abnormalities resolve with sustained alcohol abstinence, distinguishing it as a reversible condition.
Documentation Requirements
- ✓Document the history of chronic alcohol use disorder, cortisol levels and dynamic testing results, physical examination findings consistent with cushingoid appearance, and clinical improvement with alcohol cessation.
- ✓Document alcohol use disorder as a concurrent diagnosis.