Coding Diabetes Mellitus in ICD-10-CM

By Karen M. Kostick

ICD-10-CM diabetes codes complement present medical science—separate type 1 and type 2 diabetes category codes and body system combination codes represent a major improvement over ICD-9-CM.  Diabetes mellitus codes are no longer classified as controlled or uncontrolled. Instead ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia.

ICD-10-CM diabetes codes are combination codes that include the type of diabetes mellitus, body system affected, and the complications affecting that body system. The following examples apply ICD-10-CM chapter 4, “Diabetes mellitus E08-E13” tabular list instructions and illustrate diabetes mellitus code combinations and code specificity.

ICD-10-CM Diabetes Mellitus Coding Examples

ICD-10-CM diabetes codes are combinations codes that include the type of diabetes mellitus, body system affected, and the complications affecting that body system.

 

Diagnosis: A patient is seen for diabetic chronic kidney disease, stage 3. The patient has type 2 diabetes and takes insulin on a daily basis.

E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease

N18.3  Chronic kidney disease, stage 3 (moderate)

Z79.4   Long term (current) use of insulin

Rationale: There is a combination code for the type 2 diabetes with chronic kidney disease, and the tabular instructs the coder to use an additional code to identify the stage of the chronic kidney disease. At the E11 category level, the use additional code note instructs the coder to identify insulin use.

 

Diagnosis: A female patient with type 1 diabetes is seen for severe nonproliferative diabetic retinopathy with macular edema.

E10.341           Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

Rationale: There is a combination code for the type 2 diabetes with nonproliferative diabetic retinopathy with macular edema. No additional codes are necessary.

 

Diagnosis: A type 2 diabetic patient is evaluated for a chronic diabetic left foot ulcer with necrosis of muscle. The patient takes insulin on a daily basis.

E11.621           Type 2 diabetes mellitus with foot ulcer

L97.533           Non-pressure chronic ulcer of other part of left foot with necrosis of muscle

Z79.4   Long term (current) use of insulin

Rationale: The note under code E11.621 states to use additional code to identify site of ulcer (L97.4-L97.5-).

When reporting diabetes in pregnancy, many codes in chapter 15, “Pregnancy, childbirth and the puerperium (O00-O9A),” include a final character indicating the trimester of pregnancy. The trimester character assignment is valuable data to capture since poorly controlled diabetes in pregnancy during the second and third trimesters of pregnancy can result in excessively large babies, causing a medical risk to both the mother and newborn. Assignment of the final character for trimester is based on the provider’s clinical documentation of the trimester (or number of weeks) for the current admission or encounter. The time frames for the trimesters are indicated at the beginning of the chapter 15.

Coding for Diabetes Mellitus in Pregnancy

The trimester character assignment is valuable data to capture since poorly controlled diabetes in pregnancy during the second and third trimesters can cause a medical risk to both the mother and newborn.

A 32 year old female patient with type 1 diabetes is G2, P1, 26 weeks and is seen to evaluate her diabetes in pregnancy.

O24.012   Pre-existing diabetes mellitus, type 1, in pregnancy, second trimester

Z3A.26      26 weeks gestation of pregnancy

In chapter 19, “Injury, poisoning and certain other consequences of external causes (S00-T88),” category T85, Complications of other internal prosthetic devices, implants, and grafts, is used to report diabetic insulin pump complications. Category T85 requires the appropriate seventh character is added to each code to describe the encounter type (A: initial encounter, D: subsequent encounter, S: sequela).

Coding for Diabetes Mellitus with Insulin Pump

Category T85, Complications of other internal prosthetic devices, implants, and grafts, is used to report diabetic insulin pump complications.

A type 1 diabetic patient is seen in the ED to evaluate the leakage of her insulin pump. This is the patient’s initial encounter.

T85.633A   Leakage of insulin pump, initial encounter

E08.69        Diabetes mellitus due to underlying condition with other specified complication

For more on coding diabetes mellitus in ICD-10-CM, see the “Coding Notes” in this month’s print issue.

References

Moczygemba, Jackie, and Susan H. Fenton. “Lessons Learned from an ICD-10-CM Clinical Documentation Pilot Study.” Perspectives in Health Information Management (winter 2012): 1-11. http://perspectives.ahima.org.

Centers for Medicare and Medicaid Services. “2012 ICD-10-CM and GEMs.” https://www.cms.gov.

Centers for Disease Control and Prevention. “2011 National Diabetes Fact Sheet.” www.cdc.gov/diabetes/pubs.

National Center for Health Statistics. “ICD-10-CM Official Guidelines for Coding and Reporting 2012.” Available under “Tools and Resources” at www.cdc.gov/nchs.

AHIMA. ICD-10-CM Coder Training Manual. Chicago, IL: AHIMA Press, 2012.

11 Comments

  1. Thank you so much for all of this information. I learned a lot by visiting your site. There is a lot more information than I expected to find, I know that other coding students will be as thrilled as I am. I hope that you will continue to make this information public, There are so many students that really need this to continue their careers. I am thanking you again, please keep up the good work.

    With much gratitude,
    Ida Williams

    Post a Reply
    • Hello,

      Thank you for your information on icd-10 coding of diabetes. It addressed the most fundamental coding question of controlled and uncontrolled, which was not very clear from the book.

      Post a Reply
  2. I came across this article on line and thought is full of great information, however, I have a question relating to the example for coding DM with insulin pump. The dx was type I DM with leaking insulin pump. I do not think code E08.69 is correct to capture the type 1 DM. It is my understanding that E08 is used for secondary DM, not type I. There may have been a correction in subsequent journals, but I did not locate it. Can someone confirm if E08.69 is correct. Thank you. Respectfully,
    Valerie

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  3. Do we assumed the relation of the 2 diagnosis’ although Doctor did not link them together.
    e.g.
    1. type II to diabetes
    2. foot ulcer

    *(query opportunity?)

    thank you

    Post a Reply
    • Do not automatically assume a relationship between diabetes and foot ulcer. If the relationship is not stated, this would be a query opportunity.

      Post a Reply
  4. “Diabetic neuropathy uncontrolled” is documented in the assessment part of progress notes with POC.
    As per ICD 9 code we should code only – 250.62, 357.2; however, with the transition of ICD 9 to ICD 10 we found two separate codes for both Diabetic neuropathy (E11.40 -Type 2 diabetes mellitus with diabetic neuropathy, unspecified ) and Diabetes uncontrolled (E11.65 – Type 2 diabetes mellitus with hyperglycemia).
    In the above scenario, should we code both E11.40 and E11.65 or E11.40 alone? Please advice.

    Post a Reply
    • You are correct that you would need two codes to describe both the diabetic neuropathy and the diabetes uncontrolled in ICD-10-CM.

      Post a Reply
      • Thanks for your reply, i have another question in DM coding.
        The document supports Code E11.29 (DM with other kidney complication) and CKD 2 separately, in this case shall we code E11.22 and N18.2 instead of E11.29, Please advice. Thanks

        Post a Reply
        • If the only renal complication is CKD, it will be coded as E11.22 followed by N18.2.

          E11.29 would be used in a situation where the patient has a renal condition caused by diabetes that does not have its own combination code. Right now, there are combination codes for nephropathy and CKD. So if a patient has any other renal condition due to diabetes, you would use E11.29 followed by the code from Chapter 14 that describes the exact complication.

          Post a Reply
          • Thanks for the reply.
            The only renal complication for the patient is CKD 2 but the provider does not clearly link CKD 2 to diabetes instead the provider chooses the code E11.29 to describe the patient’s condition and separately documents CKD. in this case shall we consider that the renal condition that happened due to diabetes is CKD and select E11.22 n N18.2 or shall we select E11.29 n N18.2 since the causal relationship is not clearly described. Please advice.

  5. Thank you so much for all of this information. whatever i have the doubt related to diabetes,after viewing this journal learned lot.Thank you.

    Post a Reply

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