2027 ICD-10-CM Diagnosis Code E11.9Type 2 diabetes mellitus without complications
ICD-10-CM Codes›E00–E89›E08-E13›E11
- Billable — Valid for Submission
- Risk Adjusts — HCC 38
- Chronic Condition
E11.9 is a billable ICD-10-CM diagnosis code for type 2 diabetes mellitus without complications. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 637 through 639. The code is flagged as a questionable admission, since it rarely justifies inpatient admission on its own. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Diabetes mellitus without complication; and Diabetes mellitus, Type 2.
For Medicare Advantage risk adjustment, E11.9 maps to CMS-HCC Category 38 (Diabetes with No, Glycemic, or Unspecified 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, Internal Medicine, Pediatrics, and Family Practice medical specialties to designate conditions such diabetes mellitus w/o complications type 2.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for E11.9.
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when E11.9 is part of the patient record.
Diabetes: Glycemic Status Assessment Greater Than 9%
High Priority: YES
Measure Type: Intermediateoutcome
Submission Methods: Claims, Electronic Health Record, Registry
Description: Percentage of patients 18-75 years of age with diabetes who had a glycemic status assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) > 9.0% during the measurement period.
Medicare Risk Adjustment (HCC)Billing
E11.9 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.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Acanthosis nigricans
- Acanthosis nigricans due to type 2 diabetes mellitus
- Acquired acanthosis nigricans
- Atherosclerosis, deafness, diabetes, epilepsy, nephropathy syndrome
- Blood sugar charts
- Brittle diabetes mellitus
- Brittle type 2 diabetes mellitus
- Cochlear nerve disorder
- Dermopathy due to type 2 diabetes mellitus
- Diabetes mellitus
- Diabetes mellitus type 2 without retinopathy
- Diabetes monitoring check done
- Diabetes monitoring default
- Diabetes monitoring deleted
- Diabetes: practice program
- Diabetes: shared care program
- Diabetic - follow-up default
- Diabetic - good control
- Diabetic dermopathy
- Diabetic drug side effects
- Diabetic monitoring - injection sites
- Diabetic on diet only
- Diabetic on insulin
- Diabetic on insulin and oral treatment
- Diabetic on non-insulin injectable medication
- Diabetic on oral treatment
- Diabetic treatment changed
- Does rotate site of insulin injection
- Has seen dietitian - diabetes
- Hemoglobin A1C - diabetic control finding
- Hemoglobin A1c between 7 percent to 10 percent indicating borderline diabetic control
- Hemoglobin A1c between 7%-9% indicating borderline diabetic control
- Hemoglobin A1c greater than 10 percent indicating poor diabetic control
- Hemoglobin A1c less than 7 percent indicating good diabetic control
- Hemoglobin A1c within reference range
- High hemoglobin A1c level
- Insulin resistance
- Insulin treated type 2 diabetes mellitus
- Intrauterine growth restriction, short stature, early adult-onset diabetes syndrome
- Lactic acidosis due to diabetes mellitus
- Malabsorption of glucose
- Maturity onset diabetes of the young, type 2
- Megaloblastic anemia due to inborn errors of metabolism
- Megaloblastic anemia, thiamine-responsive, with diabetes mellitus and sensorineural deafness
- Metabolic acidosis due to diabetes mellitus
- Neural hearing loss
- Newly diagnosed diabetes
- Photomyoclonus, diabetes mellitus, deafness, nephropathy and cerebral dysfunction
- Pre-existing type 2 diabetes mellitus
- Thiamine-responsive megaloblastic anemia
- Type 2 diabetes mellitus
- Type 2 diabetes mellitus controlled by diet
- Type 2 diabetes mellitus in nonobese
- Understands diet - diabetes
- Urine sugar charts
- Well controlled type 2 diabetes mellitus
- Woodhouse Sakati syndrome
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 E11.9: 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.
- type 2 diabetes mellitus, without complications in remission (E11.A)
- 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 E11.9, its category, or a range that includes it.
Excludes1 5
These codes carry an Excludes1 note naming E11.9: they are not reported together with it, unless the two conditions are unrelated.
- E11.A Type 2 diabetes mellitus without complications in remissiontype 2 diabetes mellitus, without complications not in remission (E11.9)
- 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
Excludes2 1
These codes carry an Excludes2 note naming E11.9: 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 E11.9 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.
Diabetes, diabetic (mellitus) (sugar) E11.9
type 2 E11.9
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
Diabetes Type 2
Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well.
The full article covers:
- What is type 2 diabetes?
- What causes type 2 diabetes?
- Who is at risk for type 2 diabetes?
- What are the symptoms of type 2 diabetes?
- How is type 2 diabetes diagnosed?
- What are the treatments for type 2 diabetes?
- Can type 2 diabetes be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert E11.9 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About E11.9Overview
What is the ICD-10 code for type 2 diabetes mellitus without complications?
The ICD-10-CM code for type 2 diabetes mellitus without complications is E11.9 (sometimes written as E119). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is E11.9 (Type 2 diabetes mellitus) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report type 2 diabetes mellitus without complications on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does E11.9 group to?
When type 2 diabetes mellitus without complications is the principal diagnosis on an inpatient stay, it groups to MS-DRG 638, 639, 637, with relative weights from 0.6375 to 1.4127 depending on complications. Higher weights mean higher Medicare reimbursement.
Does E11.9 justify an inpatient admission?
Not on its own. The Medicare Code Editor lists this code as a questionable admission because type 2 diabetes mellitus without complications is not usually sufficient justification for admission to an acute care hospital.
Can E11.9 be reported with E11.A?
Not as a rule. The Excludes1 note on E11.9 lists "type 2 diabetes mellitus, without complications in remission (E11.A)". 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 E11.9?
E11.9 (type 2 diabetes mellitus without complications) maps to CMS-HCC Category 38 (Diabetes with No, Glycemic, or Unspecified Complications), commonly written as HCC 38, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 19 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 31.
Does E11.9 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, E11.9 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, HCC 36, and HCC 37) supersedes it when both are reported. See the full factor table on the HCC 38 category page.
