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Diabetes Mellitus ICD-10 Coding

Study Guide

Published by ICD-10 Coders Academy, LLC

CMRS. CHA.CREDITS Dr. ICD-10 Coders Academy . CPC-P. CPMB. CHL7 AHIMA Certified ICD-10 Trainer Advisory Council Member (Lead). CPC-H. Meriyala Santosh Kumar Guptha CPC. CMBS.

Type 2 Diabetes: Results from insulin resistance. sometimes combined with an absolute insulin deficiency (formerly referred to as non-insulindependent diabetes mellitus. Diabetes mellitus. . Signs and Symptoms: The classical symptoms of diabetes are polyuria (frequent urination). either because the body does not produce enough insulin. and juvenile diabetes). polydipsia (increased thirst). and presently requires the person to inject insulin (also referred to as insulin-dependent diabetes mellitus. even when the medical record states the patient requires insulin. polydipsia (increased thirst). NIDDM for short. and adult-onset diabetes). This high blood sugar produces the classical symptoms of polyuria (frequent urination). a condition in which cells fail to use insulin properly. Type II diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. and polyphagia (increased hunger). and polyphagia (increased hunger). A patient with Type II diabetes is always coded as having Type II. often simply referred to as diabetes-is a group of metabolic diseases in which a person has high blood sugar. Type 1 Diabetes: Results from the body’s failure to produce insulin. Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. IDDM for short.Diabetes Mellitus Universal blue circle symbol for diabetes. or because cells do not respond to the insulin that is produced.

1 mmol/L (200 mg/dL). Nor the does the age of onset. Glycated haemoglobin (Hb A1C) ≥ 6.5% Documentation Issues Billing and coding will undergo a significant impact with ICD-10-CM implementation. Administration of insulin has no bearing on code selection for diabetes. and may even come to require insulin. E11 and E13 include a note for assigning code Z79. includes • • • Type of diabetes Body system involved Complication . Categories E08. Type I diabetics require insulin injections to survive. Documentation is of utmost importance. E09. Symptoms of hyperglycaemia and casual plasma glucose ≥ 11. Every area in the healthcare revenue cycle will be impacted.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.Diagnosis Diabetes mellitus is characterized by recurrent or persistent hyperglycaemia. clarify with physician if there is a cause-and-effect relationship. See the code E87. and is diagnosed by demonstrating any one of the following • • • • Fasting plasma glucose level ≥ 7. If the type of diabetes is not documented in the medical record.4 for the long-term use of insulin. Diabetes codes in ICD-10-CM are combination codes.0 mmol/L (126 mg/dL) Plasma glucose ≥ 11.E11 Always clarify with the physician about the cause and effect relationship if not documented properly. Type II diabetics may improve their health with insulin injections.2 Acidosis has an exclude 1 notes (never be used same time) diabetic acidosis and reference category E08-E13. If the documentation indicates that patient has acidosis and diabetes. the default is to code type II . Selection of appropriate code depends upon the documentation.

query the physician or assign the code E11.Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema E10.Examples E10.311 .4 for long term use of insulin If insulin is given on temporary basis. Assign the code Z79. type 1 diabetes mellitus is also referred to as juvenile diabetes. For this reason. The codes are specific and stress precise documentation. though most type 1 diabetics develop the condition before reaching puberty. .Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene • • • If the type of diabetes is not mentioned in the documentation. six categories of Diabetes conditions were described. • • • • • E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus Type-1 Diabetes Category-E10 includes • • • • • • Brittle diabetes (mellitus) Diabetes (mellitus) due to autoimmune process Diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction Idiopathic diabetes (mellitus) Ketosis-prone diabetes (mellitus) Juvenile onset diabetes (mellitus) Age of the patient is the not the determining factor to assign the code E10 ICD-10-CM 4a1 The age of a patient is not the sole determining factor. don’t assign the code Z79.52 .4 In ICD-10-CM.

. Juvenile-Onset Diabetes Juvenile-onset diabetes usually begins between the age of three to 15 and is sometimes referred to as type one or insulin-dependent diabetes as sufferers of this condition are totally reliant on insulin to survive. Cannot be coded with E-10 (Excludes1) • • • • • • • • • Diabetes mellitus due to underlying condition (E08. renal insufficiency. refers to a type of insulindependent diabetes characterized by dramatic and recurrent swings in glucose levels. type 1 diabetes mellitus is also referred to as juvenile diabetes.-) Gestational diabetes (O24. manifested as albuminuria.-) Brittle Diabetes Brittle diabetes. nephrotic edema.21: Type 1 Diabetes Mellitus With Diabetic Nephropathy Type 1 diabetes mellitus with intercapillary glomerulosclerosis Type 1 diabetes mellitus with intracapillary glomerulonephrosis Type 1 diabetes mellitus with Kimmelstiel-Wilson disease Intercapillary glomerulosclerosis .-) Drug or chemical induced diabetes mellitus (E09.-) Type 2 diabetes mellitus (E11.A degenerative complication of diabetes. E10. characterized by polyuria and excessive thirst and increased appetite and weight loss and episodic ketoacidosis. diet and insulin injections are required to control the disease.9) Neonatal diabetes mellitus (P70. hypertension.4-) Hyperglycemia NOS (R73. also known as unstable diabetes or labile diabetes.-) Postprocedural diabetes mellitus (E13. The age of a patient is not the sole determining factor.-) Secondary diabetes mellitus NEC (E13.2) Postpancreatectomy diabetes mellitus (E13. often occurring for no apparent reason.The following conditions are not included. For this reason. and retinopathy. though most type 1 diabetics develop the condition before reaching puberty. Ketosis-Prone diabetes Severe diabetes mellitus with an early onset.

high blood pressure (hypertension). Alveolar bone 2. a key structure in the kidney that is composed of capillary blood vessels and which is critically necessary for the filtration of the blood.Type 1 diabetes mellitus with periodontal disease Periodontal diseases (also called periodontitis) are those diseases that affect one or more of the periodontal tissues: 1. Features of Kimmelstiel-Wilson disease include the nephrotic syndrome with excessive filtration of protein into the urine (proteinuria). ARTERIOLES. When severe.KIDNEY injuries associated with diabetes mellitus and affecting KIDNEY GLOMERULUS. and the need for chronic kidney dialysis or a kidney transplant. In ICD-10-CM.630 . If the diagnosis is diabetes with Ischemic heart disease or cerebrovascular disease. in people with a family history of diabetes or a tendency to get diabetes. and the interstitium. Cementum 4. The main sign of diabetic nephropathy is persistent protein in the urine. diabetes mellitus with skin complications is added. end-stage renal disease.62 . KIDNEY TUBULES. code them as separate entities.  Documentation Tip Documentation of Proteinuria Type-1 Diabetes Without Complications ICD-10-CM has specific code for the type 1 diabetes without any complications. and progressively impaired kidney function. Dermatologists need to document in detail about the cutaneous manifestations.Type 1 diabetes mellitus with skin complications Atherosclerosis: Diabetic atherosclerosis is coded under E10 category. and there are usually several spots. It is more common in women.Intracapillary glomerulonephrosis . Kimmelstiel-Wilson disease leads to kidney failure. NLD usually occurs more often in people with diabetes. E10. Kimmelstiel-Wilson: Diabetic nephropathy (kidney disease). It affects the network of tiny blood vessels (the microvasculature) in the glomerulus. Necrobiosis Lipoidica Diabeticorum (NLD) NLD is a rash that occurs on the lower legs. Gingiva . Kimmelstiel-Wilson disease is a kidney condition associated with long-standing diabetes. Periodontal ligament 3. Oral Complications E10.

E10. coma and possibly death. Without proper treatment. also known as Charcot joint (Charcot foot) refers to progressive degeneration of a weight bearing joint. E11 Type II Diabetes Mellitus Includes: • • • Diabetes (mellitus) due to insulin secretory defect Diabetes NOS Insulin resistant diabetes (mellitus) Use additional code to identify any insulin use (Z79. eventually leading to extreme dehydration. loss of function.610 . a process marked by bony destruction. E10.00 . and in the worst case scenario: amputation or death. the extreme dehydration will lead to seizures.4) . Onset is usually insidious. bone resorption. E13: Other Specified diabetes mellitus • • • • • 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 Use additional code to identify any insulin use (Z79.4) E11. and eventual deformity.Type 1 diabetes mellitus with diabetic neuropathic arthropathy Type 1 diabetes mellitus with Charcôt’s joints Neuropathic osteoarthropathy. This causes digestive difficulties as the food starts to move too slowly through the stomach. If this pathological process continues unchecked.Type 1 diabetes mellitus with diabetic autonomic (poly) neuropathy Type 1 diabetes mellitus with diabetic gastroparesis Gastroparesis is a diabetic complication that occurs from neuropathy of the stomach nerve (called the “vagus nerve).43 .Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemichyperosmolar coma (NKHHC) This occurs when blood sugar rises to very high levels and the body uses urination to try to get rid of the excess glucose. it could result in joint deformity. ulceration and/or superinfection. NKHS is usually brought on by illness or injury and is characterized by a blood sugar over 600 mg/dL.

eventually leading to extreme dehydration. or poisoning). E08.Secondary Diabetes: Codes under category E08. cystic fibrosis. Secondary diabetes is always caused by another condition or event (e. pancreatectomy.g.01: Diabetes mellitus due to underlying condition with hyperosmolarity with coma This occurs when blood sugar rises to very high levels and the body uses urination to try to get rid of the excess glucose. NKHS is usually brought on by illness or injury and is characterized by a blood sugar over 600 mg/dL. and E09. Drug or chemical induced diabetes mellitus.00: Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotichyperglycemic-hyperosmolar coma (NKHHC) E08. coma.. and possibly death. ICD-10-CM ICD-9-CM Code E0801 249. or unspecified . adverse effect of drug. Without proper treatment. Diabetes mellitus due to underlying condition. with hyperosmolarity with coma not stated as uncontrolled. malignant neoplasm of pancreas. identify complications/manifestations associated with secondary diabetes mellitus. the extreme dehydration will lead to seizures.20 Diabetes mellitus due to underlying condition Secondary diabetes mellitus with hyperosmolarity.

Physician may need document the following to assign the code E08. ICD-9-CM code 249.01  Diabetes Mellitus (due to underlying cause) with ketoacidosis without come: E08. body part specificity. Don’t blindly assign the code E08.11  Diabetes Mellitus (due to underlying cause) with hypoglycaemia with coma: E08.01 based on GEM Mapping to 249. It is very important for the coder to analyse the documentation and clinical scenario.20 is also mapped to 2 ICD-10-CM codes E08. CMS clearly states that GEMs should not be used for direct coding.01.20 is not an exact match to E08. ICD-10-CM has been updated to reflect the current clinical understanding and technological advancements of medicine.20) It will be a big challenge for the coders to assign the ICD-10-CM Code based on GEMs. It contains a more extensive vocabulary of clinical concepts.01.10  Diabetes Mellitus (due to underlying cause) with ketoacidosis with coma: E08.ICD-9-CM Code 249. and other components from which codes are built.00  Diabetes Mellitus (due to underlying cause) with hypersomolarity with come: E08.641  Diabetes Mellitus (due to underlying cause) with hypoglycaemia without coma: E08.01: Diabetes mellitus due to underlying condition with hyperosmolarity with coma E09. 1) Cause for Diabetes Mellitus 2) Use of Insulin 3) Level of blood sugar 4) Dehydration 5) Comatose condition  Diabetes Mellitus (due to underlying cause) with hypersomolarity without coma: E08. patient encounter information. and the code descriptions are designed to provide a more consistent level of detail.00 (diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma [NKHHC] is also mapped to 249.01: Drug or chemical-induced diabetes mellitus with hyperosmolarity with coma ICD-10-CM Code E08.649 .20.

E08.-) • Drug or chemical induced diabetes mellitus (E09.3x1-. Mechanical complication of other specified internal and external prosthetic devices. (b) Overdose of insulin due to insulin pump failure The principal or first listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin.43: Other specified diabetes mellitus with diabetic autonomic (poly) neuropathy Other specified diabetes mellitus with diabetic gastroparesis Complications due to insulin pump malfunction (a) Underdose of insulin due to insulin pump failure An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.21: Diabetes mellitus due to underlying condition with diabetic nephropathy Diabetes mellitus due to underlying condition with intercapillary glomerulosclerosis Diabetes mellitus due to underlying condition with intracapillary glomerulonephrosis Diabetes mellitus due to underlying condition with Kimmelstiel-Wilson disease Other Specified Diabetes Mellitus ICD-10-CM has specific codes for the Other Specified Diabetes Mellitus. implants and grafts. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.6.6-. Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs.4-) • Neonatal diabetes mellitus (P70.2) • Type 2 diabetes mellitus (E11. Mechanical complication of other specified internal and external prosthetic devices. .3x6-. Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs.-) • Gestational diabetes (O24. accidental (unintentional). followed by code T38. The following are not coded as Other Specified Diabetes • Diabetes (mellitus) due to autoimmune process (E10. as the principal or first listed code. implants and grafts. that specifies the type of pump malfunction.-) • Diabetes mellitus due to underlying condition (E08.-) Any condition listed above is included in E13 category (Secondary Diabetes Mellitus NEC) E13. followed by code T38. should also be T85.-) • Diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.

should be used with a code from O24. Long-term (current) use of insulin. followed by the appropriate diabetes code(s) (E08-E13) Gestational (pregnancy induced) diabetes Gestational (pregnancy induced) diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. “Trimester of Pregnancy” is not mentioned to assign code from category O24 (Diabetes mellitus in pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus. Documentation Issues Case #1: The patient was admitted through ED with severe abdominal cramping. first. Codes for gestational diabetes are in subcategory O24. No other code from category O24. In the above case. Trimesters are defined as follows: • • • 1st trimester – less than 14 weeks 0 days 2nd trimester – 14 weeks 0 days to less than 28 weeks 0 days 3rd trimester – 28 weeks 0 days until delivery . An abnormal glucose tolerance in pregnancy is assigned a code from subcategory O99. and the puerperium.Diabetes mellitus in pregnancy Diabetes mellitus is a significant complicating factor in pregnancy. should not be assigned with codes from subcategory O24. childbirth. Diabetes mellitus in pregnancy. The patient has pre-existing diabetes mellitus. and the puerperium. childbirth. Code Z79.4.4. childbirth. and the puerperium) One of the key specific Chapter 15 ICD-10-CM guidelines includes the final character for the trimester.4 The codes under subcategory O24.4 include diet controlled and insulin controlled. Gestational diabetes mellitus. Ultrasound showed a complex right lower quadrant mass with free fluid in the pelvis. It was decided to perform a laparoscopy for the possibility of an ectopic pregnancy. only the code for insulin-controlled is required.81.4. If a patient with gestational diabetes is treated with both diet and insulin. Abnormal glucose complicating pregnancy. documentation of exact weeks and days is necessary. Diabetes mellitus in pregnancy. and the puerperium. It also puts the woman at greater risk of developing diabetes after the pregnancy. type I. childbirth. To code appropriately as per ICD-10. Pregnant women who are diabetic should be assigned a code O24.

Z49. stage 4 (severe) Z79.40: Type 2 diabetes mellituswith diabetic neuropathy. E10. stage 4 for dialysis. Physician identifies that patient has been compliant with antidiabetic drugs. E11. Patient is Type II diabetic.Case #2: A patient is admitted with chronic kidney disease. E89. unspecified Z79.65: Type 1 diabetes mellitus with hyperglycemia T383X5A: Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs .1 (postsurgical hypoinsulinemia) E08.9: Type 2 diabetes mellitus without complications N18.4 (acquired absence organ) Case #6: A Type I diabetic male is seen in the clinic with hypoglycemia.31: Encounter for adequacy testing for hemodialysis .9: Obstructive and reflux uropathy. Patient is Type II diabetic controlled by insulin. controlled by insulin. Patient history identifies a previous history of pancreatomy. Blood workup revealed hypoglycemia.4: Long term (current) use of insulin Case #4: A 56-year-old male was presented to ED with coma.641: Type 1 diabetes mellitus with hypoglycemia with coma Case #5: A 43-year-old is admitted with diabetic ketoacidosis with coma. E10. Type 2 diabetes mellitus without complications E11.11 (diabetes mellitus due to underlying condition with ketoacidosis with coma) Z79.4: Long term (current) use of insulin Case #3: A 60-year-old female is seen in the clinic for her neurogenic bladder disorder secondary to diabetes.4: Chronic kidney disease. unspecified N13.

Notes .