2027 ICD-10-CM Diagnosis Code E13.11Other specified diabetes mellitus with ketoacidosis with coma
ICD-10-CM Codes›E00–E89›E08-E13›E13
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 36
- Chronic Condition
E13.11 is a billable ICD-10-CM diagnosis code for other specified 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, due to underlying condition, drug or chemical induced, or other specified type.
For Medicare Advantage risk adjustment, E13.11 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.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when E13.11 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
E13.11 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.
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 E13.11: its own notes plus those printed at E13 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 genetic defects of beta-cell function
- diabetes mellitus due to genetic defects in insulin action
- postpancreatectomy diabetes mellitus
- postprocedural diabetes mellitus
- secondary diabetes mellitus NEC
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- diabetes (mellitus) due to autoimmune process (E10.-)
- diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
- diabetes mellitus due to underlying condition (E08.-)
- drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- 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 E13.11, its category, or a range that includes it.
Excludes1 13
These codes carry an Excludes1 note naming E13.11: they are not reported together with it, unless the two conditions are unrelated.
- E08 Diabetes mellitus due to underlying conditionpostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E08 Diabetes mellitus due to underlying conditionpostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E08 Diabetes mellitus due to underlying conditionsecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E09 Drug or chemical induced diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E10 Type 1 diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellituspostpancreatectomy diabetes mellitus (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellituspostprocedural diabetes mellitus (E13.-) names E13.-, which includes this code
- E11 Type 2 diabetes mellitussecondary diabetes mellitus NEC (E13.-) names E13.-, which includes this code
- E87.2 Acidosisdiabetic acidosis - see categories E08-E10, E11, E13 with ketoacidosis names E13, which includes this code
Excludes2 1
These codes carry an Excludes2 note naming E13.11: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 1
These codes say to code first a condition named in the note, and E13.11 is one of the conditions named.
Use Additional Code 3
These codes say to use an additional code from the note, and E13.11 is one of the codes named.
- O24.8 Other pre-existing diabetes mellitus in pregnancy, childbirth, and the puerperiumfrom categories E08, E09 and E13 to further identify any manifestation names E13, which includes this code
- O24.9 Unspecified diabetes mellitus in pregnancy, childbirth and the puerperiumfrom categories E08, E09 and E13 to further identify any manifestation names E13, which includes this code
- Z90.41 Acquired absence of pancreasdiabetes mellitus, postpancreatectomy (E13.-) names E13.-, 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.
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 E13.11 to ICD-9-CMHistory
Code HistoryHistory
Questions About E13.11Overview
What is the ICD-10 code for other specified diabetes mellitus with ketoacidosis with coma?
The ICD-10-CM code for other specified diabetes mellitus with ketoacidosis with coma is E13.11 (sometimes written as E1311). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is E13.11 (Other specified diabetes mellitus with ketoacidosis) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other specified diabetes mellitus with ketoacidosis with coma on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does E13.11 group to?
When other specified 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 E13.11 a CC or MCC?
CMS lists E13.11 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 E13.11 be reported with a code from E10?
Not as a rule. The Excludes1 note at E13, which applies to E13.11, lists "diabetes (mellitus) due to autoimmune process (E10.-)". 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 E13.11?
E13.11 (other specified 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 E13.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, E13.11 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.
