ICD-10 Coding for Type 2 Diabetes Mellitus with Hyperglycemia(E11.65)
Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes Mellitus with Hyperglycemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Type 2 Diabetes Mellitus with Hyperglycemia
E11.0-E11.9Primary Range
Type 2 Diabetes Mellitus
This range includes all codes related to Type 2 Diabetes Mellitus, including those with specific complications such as hyperglycemia.
Key Information: ICD-10 code for type 2 diabetes with hyperglycemia
Essential facts and insights about Type 2 Diabetes Mellitus with Hyperglycemia
Primary ICD-10-CM Code for diabetes mellitus type 2 with hyperglycemia
Decision Criteria
clinical Criteria
- Documented blood glucose levels and symptoms of hyperglycemia.
documentation Criteria
- Provider must specify hyperglycemia, not just 'uncontrolled diabetes'.
Applicable To
- Type 2 diabetes with high blood sugar
Excludes
- Type 1 diabetes mellitus with hyperglycemia (E10.65)
Clinical Validation Requirements
- Blood glucose >140 mg/dL (fasting) or >180 mg/dL (random)
- A1C ≥7%
- Symptoms such as polyuria, polydipsia
Code-Specific Risks
- Avoid using E11.9 when hyperglycemia is present.
Coding Notes
- Ensure hyperglycemia is explicitly documented by the provider.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Type 2 Diabetes Mellitus with Hyperglycemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.
Impact
Clinical: Leads to inadequate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Educate providers on the importance of specificity., Implement documentation audits.
Impact
Reimbursement: Incorrect coding may lead to improper reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use E11.65 to accurately reflect hyperglycemia.
Impact
Coding 'uncontrolled diabetes' without specifying hyperglycemia or hypoglycemia.
Mitigation Strategy
Require explicit documentation of blood glucose levels and control status.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Type 2 Diabetes Mellitus with Hyperglycemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Type 2 Diabetes Mellitus with Hyperglycemia
Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes Mellitus with Hyperglycemia. These templates include all required elements for proper coding and billing.
Primary Care Visit
Specialty: EndocrinologyRequired Elements
- Patient symptoms
- Blood glucose levels
- A1C results
- Medication adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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