2027 ICD-10-CM Diagnosis Code E11.11Type 2 diabetes mellitus with ketoacidosis with coma
ICD-10-CM Codes›E00–E89›E08-E13›E11
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 36
- Chronic Condition
E11.11 is a billable ICD-10-CM diagnosis code for type 2 diabetes mellitus with ketoacidosis with coma. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 8, 10, 19, 637 through 639. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 352 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coma; stupor; and brain damage; Diabetes mellitus with complication; and Diabetes mellitus, Type 2.
For Medicare Advantage risk adjustment, E11.11 maps to CMS-HCC Category 36 (Diabetes with Severe Acute Complications) under the V28 model, adding a risk factor of about 0.166 for a community, non-dual, aged beneficiary in payment year 2027.
This medical diagnosis code is frequently used in Family Practice medical specialties to designate conditions such diabetes mellitus with complications type 2.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
E11.11 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Coding GuidelinesGuidance
The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 - E13 as needed to identify all of the associated conditions that the patient has.
If the type of diabetes mellitus is not documented in the medical record the default is E11.-, Type 2 diabetes mellitus.
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to E11.11: its own notes plus those printed at E11 and Chapter 4. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- diabetes (mellitus) due to insulin secretory defect
- diabetes NOS
- insulin resistant diabetes (mellitus)
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- postpancreatectomy diabetes mellitus (E13.-)
- postprocedural diabetes mellitus (E13.-)
- secondary diabetes mellitus NEC (E13.-)
- type 1 diabetes mellitus (E10.-)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Notes
General instructions on how these codes are used.
- All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name E11.11, its category, or a range that includes it.
Excludes1 5
These codes carry an Excludes1 note naming E11.11: they are not reported together with it, unless the two conditions are unrelated.
- E08 Diabetes mellitus due to underlying conditiontype 2 diabetes mellitus (E11.-) names E11.-, which includes this code
- E09 Drug or chemical induced diabetes mellitustype 2 diabetes mellitus (E11.-) names E11.-, which includes this code
- E10 Type 1 diabetes mellitustype 2 diabetes mellitus (E11.-) names E11.-, which includes this code
- E87.2 Acidosisdiabetic acidosis - see categories E08-E10, E11, E13 with ketoacidosis names E11, which includes this code
- E11.A Type 2 diabetes mellitus without complications in remission
Excludes2 1
These codes carry an Excludes2 note naming E11.11: its condition is not part of those codes, and both may be reported when the patient has both.
Use Additional Code 2
These codes say to use an additional code from the note, and E11.11 is one of the codes named.
- O24.1 Pre-existing type 2 diabetes mellitus, in pregnancy, childbirth and the puerperiumfrom category E11 to further identify any manifestations names E11, which includes this code
- O24.3 Unspecified pre-existing diabetes mellitus in pregnancy, childbirth and the puerperiumfrom category E11 to further identify any manifestation names E11, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Diabetes Mellitus, Type 2
a subclass of diabetes mellitus that is not insulin-responsive or dependent (niddm). it is characterized initially by insulin resistance and hyperinsulinemia; and eventually by glucose intolerance; hyperglycemia; and overt diabetes. type ii diabetes mellitus is no longer considered a disease exclusively found in adults. patients seldom develop ketosis but often exhibit obesity.
Patient EducationClinical
Coma
A coma is a deep state of unconsciousness. An individual in a coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as brain injury.
Read the full article at MedlinePlus
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Convert E11.11 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement E11.11 replaces the following previously assigned code(s):
- E11.69 - Type 2 diabetes mellitus with other specified complication
- R40.20 - Unspecified coma
Questions About E11.11Overview
What is the ICD-10 code for type 2 diabetes mellitus with ketoacidosis with coma?
The ICD-10-CM code for type 2 diabetes mellitus with ketoacidosis with coma is E11.11 (sometimes written as E1111). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is E11.11 (Type 2 diabetes mellitus with ketoacidosis) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report type 2 diabetes mellitus with ketoacidosis with coma on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does E11.11 group to?
When type 2 diabetes mellitus with ketoacidosis with coma is the principal diagnosis on an inpatient stay, it groups to MS-DRG 638, 639, 8, 10, 637, 19, with relative weights from 0.6375 to 7.5461 depending on complications. Higher weights mean higher Medicare reimbursement.
Is E11.11 a CC or MCC?
CMS lists E11.11 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 352 closely related codes in its exclusion list.
Can E11.11 be reported with a code from E08?
Not as a rule. The Excludes1 note at E11, which applies to E11.11, lists "diabetes mellitus due to underlying condition (E08.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is E11.11?
E11.11 (type 2 diabetes mellitus with ketoacidosis with coma) maps to CMS-HCC Category 36 (Diabetes with Severe Acute Complications), commonly written as HCC 36, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 17 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 30.
Does E11.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, E11.11 adds a risk adjustment factor of about 0.166 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.166 to 0.280 depending on the payment segment). A more severe related category (HCC 35) supersedes it when both are reported. See the full factor table on the HCC 36 category page.
