ICD-10 E11.9
Billable / Specific HCC v28: 19Type 2 diabetes mellitus without complications
About ICD-10-CM E11.9
ICD-10-CM code E11.9 represents Type 2 diabetes mellitus without complications. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.9 became effective on October 1, 2025.
Coding Tips for E11.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Use E11.9 only when the chart truly contains no documented complication. If the patient has any of the following, code the specific E11.X variant instead: hyperglycemia (E11.65), hypoglycemia (E11.64), diabetic neuropathy (E11.40-E11.49), retinopathy (E11.31-E11.39), kidney disease (E11.21-E11.22), foot ulcer (E11.621), or any complication mentioned in the assessment. Payers and CMS RADV audits routinely deny or downgrade E11.9 claims when the chart documents a specific complication elsewhere in the record.
E11.9 is a CMS-HCC v28 risk-adjustment code (category 19). 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with E11.9. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- type 2 diabetes mellitus, without complications in remission (E11.A)
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 E11.9
Local Coverage Determinations (LCDs) from CMS MACs that list E11.9 as a covered diagnosis.
Showing top 10 of 319 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E11.9.
1 Aetna
1 Cigna
5 Medicare
CPT Codes Commonly Billed with E11.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99490 Chronic Care Management — 2+ chronic conditions required Internal Medicine
- 99203 New patient office visit — common complaints plus chronic conditions: HTN, diabetes, hyperlipidemia, asthma, GERD, back pain, migraine, tachycardia, prediabetes Primary Care
- 99204 New patient office visit — multiple chronic conditions: HTN, T2DM, hyperlipidemia, asthma, anxiety, depression, obesity, IBS, COPD, thyroid, anemia, CAD, sleep apnea, psoriasis, RA Primary Care
- 99211 Established patient minimal visit — BP check, medication refill, nurse visit, immunization admin, post-op follow-up, injury follow-up Primary Care
- 99213 Established patient — HTN follow-up, diabetes management, hyperlipidemia, asthma, anxiety, common complaints, back pain, GERD, migraine, acne, joint pain, prediabetes, obesity, anemia, hypothyroid, fatigue Primary Care
- 93000 EKG 12-lead — tachycardia, bradycardia, palpitations, HTN, CAD, AFib, arrhythmia, chest pain, syncope, cardiomyopathy, AV block, bundle branch block, SVT, VT, diabetes screening, abnormal EKG Cardiology
- 93015 Stress test cardiovascular — chest pain, CAD, angina, tachycardia, dyspnea, HTN, diabetes, syncope, cardiac screening Cardiology
- 80053 Comprehensive metabolic panel — diabetes, HTN, CKD, hyperlipidemia, electrolyte disorders, anemia, thyroid, prediabetes, abnormal labs, routine exam, screening Laboratory
- 80048 Basic metabolic panel — diabetes, HTN, CKD, electrolyte disorders, abnormal labs, routine exam, HF, dehydration Laboratory
- 80061 Lipid panel — hyperlipidemia, hypercholesterolemia, hypertriglyceridemia, CAD, HTN, diabetes, lipid screening, family hx heart disease, obesity Laboratory
Convert E11.9 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 |
|---|---|---|
| E11.9 | 25000 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E11.9
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.9, Billing FAQ
Is ICD-10 code E11.9 billable? +
Yes, E11.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for E11.9? +
Type 1 Excludes (never code together with E11.9): type 2 diabetes mellitus, without complications in remission (E11.A)
Does E11.9 affect Medicare Advantage HCC risk adjustment? +
Yes. E11.9 maps to CMS-HCC v28 category 19. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E11.9? +
Procedures frequently paired with E11.9 include: 99490, 99203, 99204, 99211, 99213.
What ICD-9 codes does E11.9 map to? +
Per CMS GEMs, E11.9 maps to ICD-9 codes: 25000. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team