ICD-10 E11.11
Billable / Specific HCC v28: 17 MCCType 2 diabetes mellitus with ketoacidosis with coma
About ICD-10-CM E11.11
ICD-10-CM code E11.11 represents Type 2 diabetes mellitus with ketoacidosis with coma. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.11 became effective on October 1, 2025.
Coding Tips for E11.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E11.11 is a CMS-HCC v28 risk-adjustment code (category 17). 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.
E11.11 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
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, MCC
0530:352 codes Type 2 diabetes mellitus with ketoacidosis with coma. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for E11.11
Local Coverage Determinations (LCDs) from CMS MACs that list E11.11 as a covered diagnosis.
Showing top 10 of 253 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E11.11.
5 Medicare
CPT Codes Commonly Billed with E11.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95860 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95874 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95937 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- G0255 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95861 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95913 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95887 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95863 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95873 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95909 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
Codes Adjacent To E11.11
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.11, Billing FAQ
Is ICD-10 code E11.11 billable? +
Yes, E11.11 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E11.11 affect Medicare Advantage HCC risk adjustment? +
Yes. E11.11 maps to CMS-HCC v28 category 17. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E11.11 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with E11.11? +
Procedures frequently paired with E11.11 include: 95860, 95874, 95937, G0255, 95861.
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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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