E13.69

E13.69: Other specified diabetes mellitus with other specified complication

Billable / specific codeICD-10-CM

E13.69 is a billable, specific ICD-10-CM code for other specified diabetes mellitus with other specified complication. It is valid for submission on a claim.

Check E13.69 with the rest of the claim: free scrubber

Use additional code

Add a secondary code to capture the detail described below.

code to identify complication

Excludes1 inherited from the categories above E13.69

A category’s note binds every code beneath it.

Written on E13: Other specified diabetes mellitus

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.-)

Other codes that can never be billed with E13.69

Their own Excludes1 notes name this code, so the conflict is not listed above.

E08Diabetes mellitus due to underlying condition
E09Drug or chemical induced diabetes mellitus
E10Type 1 diabetes mellitus
E11Type 2 diabetes mellitus

Risk adjustment

E13.69 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 37 Diabetes with Chronic Complications0.166 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

E13.69 is named in 27 Medicare coverage policies: 27 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52464Glucose Monitor - Policy Article
A52501Therapeutic Shoes for Persons with Diabetes - Policy Article
A52507External Infusion Pumps - Policy Article
A52996Billing and Coding: Routine Foot Care

Alphabetic index entries that lead here

Diabetes, diabetic›specified type NEC›with›complication›specified NEC

Code history

Unchanged in every release from FY2024 to FY2027.