ICD-10 Coding for Diabetes Mellitus(E11.9, E11.22)
Complete ICD-10-CM coding and documentation guide for Diabetes Mellitus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetes Mellitus
E08-E13Primary Range
Diabetes mellitus
This range includes all types of diabetes mellitus, including type 1, type 2, and secondary diabetes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.9 | Type 2 diabetes mellitus without complications | Use when type 2 diabetes is documented without any complications. |
|
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Use when type 2 diabetes is documented with chronic kidney disease. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for type 2 diabetes
Essential facts and insights about Diabetes Mellitus
Primary ICD-10-CM Codes for diabetes type inspiration
Decision Criteria
clinical Criteria
- Patient diagnosed with type 2 diabetes without complications.
Applicable To
- Type 2 diabetes mellitus
Excludes
- Type 1 diabetes mellitus (E10.-)
Clinical Validation Requirements
- HbA1c ≥6.5%
- Fasting glucose ≥126 mg/dL
Code-Specific Risks
- Risk of undercoding if complications are present but not documented.
Coding Notes
- Ensure to document the absence of complications clearly.
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease
Use when type 2 diabetes is documented with chronic kidney disease.
Applicable To
- Diabetic nephropathy
Excludes
- Acute kidney failure (N17.-)
Clinical Validation Requirements
- Diagnosis of CKD stage 1-5 or ESRD
- HbA1c ≥6.5%
Coding Notes
Document CKD stage for precise coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.4Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetes Mellitus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.9.
Impact
Clinical: Ambiguous treatment plans., Regulatory: Potential audit flags., Financial: Inaccurate reimbursement.
Mitigation Strategy
Clarify glucose levels in notes., Use specific terms like 'uncontrolled hyperglycemia'.
Impact
Reimbursement: Potential loss of additional reimbursement for complications., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Review patient records for any documented complications and code accordingly.
Impact
Failure to code documented complications can lead to audit issues.
Mitigation Strategy
Regularly review and update coding practices.
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 Diabetes Mellitus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetes Mellitus
Use these documentation templates to ensure complete and accurate documentation for Diabetes Mellitus. These templates include all required elements for proper coding and billing.
Type 2 Diabetes with Complications
Specialty: EndocrinologyRequired Elements
- Diabetes type and control status
- Complications and their severity
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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