ICD-10 Coding for Diabetes with Hyperglycemia(E11.65)
Complete ICD-10-CM coding and documentation guide for Diabetes with Hyperglycemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetes with Hyperglycemia
E08-E13Primary Range
Diabetes mellitus
This range includes all types of diabetes mellitus, including those with complications such as hyperglycemia.
Key Information: ICD-10 code for diabetes with hyperglycemia
Essential facts and insights about Diabetes with Hyperglycemia
Primary ICD-10-CM Code for diabetes with hyperglycemia
Decision Criteria
clinical Criteria
- Presence of hyperglycemia symptoms and lab values.
documentation Criteria
- Provider documentation of 'hyperglycemia' or 'uncontrolled' diabetes.
Applicable To
- Type 2 diabetes with hyperglycemia
- Poorly controlled type 2 diabetes
Excludes
- Type 1 diabetes mellitus with hyperglycemia (E10.65)
Clinical Validation Requirements
- Blood glucose >140 mg/dL
- A1C ≥6.5%
- Provider documentation of hyperglycemia
Code-Specific Risks
- Coding based solely on lab values without provider documentation.
Coding Notes
- Ensure provider documentation explicitly links diabetes to hyperglycemia.
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.
Type 1 diabetes mellitus with hyperglycemia
E10.65Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetes 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 misinterpretation of the patient's condition., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential claim denials due to incorrect coding.
Mitigation Strategy
Educate providers on the importance of specifying hyperglycemia., Implement documentation audits.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure provider documentation explicitly states hyperglycemia.
Impact
Lack of specific terms like 'hyperglycemia' in documentation.
Mitigation Strategy
Regular training and audits to ensure compliance.
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 with Hyperglycemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetes with Hyperglycemia
Use these documentation templates to ensure complete and accurate documentation for Diabetes with Hyperglycemia. These templates include all required elements for proper coding and billing.
Outpatient follow-up for diabetes management
Specialty: EndocrinologyRequired Elements
- Patient's current glucose levels
- A1C results
- Symptoms of hyperglycemia
- Medication adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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