ICD-10 E13.641
Billable / Specific HCC v28: 17 MCCOther specified diabetes mellitus with hypoglycemia with coma
About ICD-10-CM E13.641
ICD-10-CM code E13.641 represents Other specified diabetes mellitus with hypoglycemia with coma. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E13). The 2026 edition of ICD-10-CM E13.641 became effective on October 1, 2025.
Coding Tips for E13.641
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E13.641 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.
E13.641 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
codes Other specified diabetes mellitus with hypoglycemia 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 E13.641
Local Coverage Determinations (LCDs) from CMS MACs that list E13.641 as a covered diagnosis.
Showing top 10 of 173 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E13.641.
5 Medicare
CPT Codes Commonly Billed with E13.641
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- J2353 CMS LCD: Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin� LAR Depot) CMS LCD
Convert E13.641 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 |
|---|---|---|
| E13.641 | 24930 | 10000 |
| E13.641 | 25030 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E13.641
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E13.641, Billing FAQ
Is ICD-10 code E13.641 billable? +
Yes, E13.641 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E13.641 affect Medicare Advantage HCC risk adjustment? +
Yes. E13.641 maps to CMS-HCC v28 category 17. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E13.641 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 E13.641? +
Procedures frequently paired with E13.641 include: J2353.
What ICD-9 codes does E13.641 map to? +
Per CMS GEMs, E13.641 maps to ICD-9 codes: 24930, 25030. 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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