ICD-10 E10.65
Billable / Specific HCC v28: 18Type 1 diabetes mellitus with hyperglycemia
About ICD-10-CM E10.65
ICD-10-CM code E10.65 represents Type 1 diabetes mellitus with hyperglycemia. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E10). The 2026 edition of ICD-10-CM E10.65 became effective on October 1, 2025.
Coding Tips for E10.65
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E10.65 is a CMS-HCC v28 risk-adjustment code (category 18). 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.
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.
Medicare LCD Coverage for E10.65
Local Coverage Determinations (LCDs) from CMS MACs that list E10.65 as a covered diagnosis.
Showing top 10 of 209 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E10.65.
5 Medicare
CPT Codes Commonly Billed with E10.65
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
- 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
- 83036 Hemoglobin A1c — type 2 diabetes, type 1 diabetes, prediabetes, diabetes screening, diabetic kidney disease, diabetic retinopathy Laboratory
- 95250 Continuous glucose monitoring — uncontrolled T2DM, uncontrolled T1DM, diabetes management, prediabetes Endocrinology
- 11006 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
- 97607 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
- 11008 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
- 11005 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
- 11012 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
- 11010 CMS LCD: Billing and Coding: Wound and Ulcer Care CMS LCD
Convert E10.65 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 |
|---|---|---|
| E10.65 | 25081 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E10.65
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E10.65, Billing FAQ
Is ICD-10 code E10.65 billable? +
Yes, E10.65 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E10.65 affect Medicare Advantage HCC risk adjustment? +
Yes. E10.65 maps to CMS-HCC v28 category 18. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E10.65? +
Procedures frequently paired with E10.65 include: 99205, 99215, 83036, 95250, 11006.
What ICD-9 codes does E10.65 map to? +
Per CMS GEMs, E10.65 maps to ICD-9 codes: 25081. 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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