E71.32 ICD-10-CM Code: Disorders of ketone metabolism
E71.32 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)
E71.32
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDisorders of ketone metabolism
A metabolic disorder affecting the body's ability to produce or use ketones, which are alternative fuel sources the body creates during fasting or low carbohydrate intake.
Buddy Insight
Disorders of ketone metabolism affect the body's ability to produce or utilize ketone bodies as alternative fuel during fasting or metabolic stress, potentially causing life-threatening metabolic crises.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
MappedHCC 23
RAF 0.194
ACA/HHS
MappedHCC 28
Varies by metal level
ESRD/PACE
MappedHCC 23
RAF 0.036
RXHCC
MappedHCC 43
RAF 0.063
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E71.32 in this effective period.
Excludes 2
Official- carnitine deficiency due to inborn error of metabolism (E71.42)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E71.32 in this effective period.
Excludes 1
Official- peroxisomal disorders (E71.5)
- Refsum's disease (G60.1)
- Schilder's disease (G37.0)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E71.32 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E71.32 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E71.32 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is E71.32 an HCC code?
Yes. E71.32 maps to Other Significant Endocrine and Metabolic Disorders under the V24 model but is not retained in V28.
- Code
- E71.32
- Description
- Disorders of ketone metabolism
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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 E71.32 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for E71.32
For E71.32 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 E71.32 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E71.32 is the ICD-10-CM diagnosis code for disorders of ketone metabolism. A metabolic disorder affecting the body's ability to produce or use ketones, which are alternative fuel sources the body creates during fasting or low carbohydrate intake. E71.32 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
Under the older CMS-HCC V24 model, E71.32 maps to Other Significant Endocrine and Metabolic Disorders (HCC 23) with a community, non-dual, aged base RAF weight of 0.194. 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.
Determine if the disorder involves ketone production (overproduction) or ketone utilization (deficiency) as this affects clinical management. Because E71.32 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 E71.32 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Determine if the disorder involves ketone production (overproduction) or ketone utilization (deficiency) as this affects clinical management
- •Look for associated conditions like diabetic ketoacidosis or hypoketotic hypoglycemia that may require separate coding
Clinical Significance
Disorders of ketone metabolism affect the body's ability to produce or utilize ketone bodies as alternative fuel during fasting or metabolic stress, potentially causing life-threatening metabolic crises. Conditions include succinyl-CoA:3-oxoacid CoA transferase (SCOT) deficiency and mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency. These patients are at risk of severe metabolic acidosis during illness or prolonged fasting.
Documentation Requirements
- ✓Document whether the disorder involves ketone overproduction (ketolysis defect) or underproduction (ketogenesis defect), specific enzyme deficiency if identified, blood ketone and glucose levels during episodes, and management plan for illness and fasting protocols.
- ✓Record any history of metabolic crises.
Commonly Confused Codes
- •E71.39 (Other disorders of fatty-acid metabolism) which does not specify ketone involvement
- •E87.2 (Acidosis) which describes the metabolic consequence rather than the underlying disorder
- •E13.10 (Other specified diabetes mellitus with ketoacidosis) which is a diabetic, not inherited, ketone disorder.