ICD-10 E10.52
Billable / Specific HCC v28: 106 CCType 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
About ICD-10-CM E10.52
ICD-10-CM code E10.52 represents Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E10). The 2026 edition of ICD-10-CM E10.52 became effective on October 1, 2025.
Coding Tips for E10.52
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E10.52 is a CMS-HCC v28 risk-adjustment code (category 106). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
E10.52 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under E10.52. Per CMS ICD-10-CM Tabular 2026.
- Type 1 diabetes mellitus with diabetic gangrene
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for E10.52
Local Coverage Determinations (LCDs) from CMS MACs that list E10.52 as a covered diagnosis.
Showing top 10 of 1,141 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E10.52.
5 Medicare
CPT Codes Commonly Billed with E10.52
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 29405 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 95992 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29280 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97010 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29515 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97550 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97116 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97546 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29445 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29075 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
Convert E10.52 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E10.52 | 25071 | 10111 |
| E10.52 | 44381 | 10112 |
| E10.52 | 7854 | 10113 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E10.52
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E10.52, Billing FAQ
Is ICD-10 code E10.52 billable? +
Yes, E10.52 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to E10.52? +
ICD-10 E10.52 includes: Type 1 diabetes mellitus with diabetic gangrene.
Does E10.52 affect Medicare Advantage HCC risk adjustment? +
Yes. E10.52 maps to CMS-HCC v28 category 106. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E10.52 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with E10.52? +
Procedures frequently paired with E10.52 include: 29405, 95992, 29280, 97010, 29515.
What ICD-9 codes does E10.52 map to? +
Per CMS GEMs, E10.52 maps to ICD-9 codes: 25071, 44381, 7854. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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