ICD-10 Coding for Empagliflozin(E11.9, I50.23, E11.22)
Complete ICD-10-CM coding and documentation guide for Empagliflozin. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Empagliflozin
E11-E11.9Primary Range
Type 2 Diabetes Mellitus
Empagliflozin is primarily used for managing Type 2 Diabetes Mellitus.
Chronic Kidney Disease
Empagliflozin is used in patients with CKD, especially those with 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 managing Type 2 Diabetes Mellitus without specific complications. |
|
| I50.23 | Acute on chronic systolic (congestive) heart failure | Use when empagliflozin is prescribed for heart failure with reduced ejection fraction. |
|
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Use when managing Type 2 Diabetes Mellitus with CKD. |
|
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: How is empagliflozin coded in ICD-10?
Essential facts and insights about Empagliflozin
Primary ICD-10-CM Codes for empagliflozin
Decision Criteria
clinical Criteria
- Patient diagnosed with Type 2 Diabetes Mellitus
Applicable To
- Type 2 diabetes
Excludes
- Type 1 diabetes (E10.-)
Clinical Validation Requirements
- Diagnosis of Type 2 Diabetes Mellitus
- HbA1c levels indicating diabetes
Code-Specific Risks
- Ensure diabetes type is specified to avoid default coding errors.
Coding Notes
- Ensure to document the type of diabetes and any associated conditions.
I50.23 - Acute on chronic systolic (congestive) heart failure
Use when empagliflozin is prescribed for heart failure with reduced ejection fraction.
Applicable To
- Heart failure with reduced ejection fraction
Excludes
- Heart failure with preserved ejection fraction (I50.33)
Clinical Validation Requirements
- Ejection fraction ≤40%
- BNP >100 pg/mL
Coding Notes
Document heart failure classification and treatment details.
E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease
Use when managing Type 2 Diabetes Mellitus with CKD.
Applicable To
- Diabetic nephropathy
Excludes
- Chronic kidney disease without diabetes (N18.-)
Clinical Validation Requirements
- eGFR <60
- UACR ≥30 mg/g
Coding Notes
Document the causal relationship between diabetes and CKD.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Empagliflozin to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.9.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always specify Type 2 Diabetes Mellitus when coding., Use E11.9 only when no complications are present.
Impact
Reimbursement: May result in denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient medication use.
Mitigation Strategy
Always include Z79.84 with E11.9 when empagliflozin is used.
Impact
Failure to code long-term medication use.
Mitigation Strategy
Implement regular audits of medication 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 Empagliflozin, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Empagliflozin
Use these documentation templates to ensure complete and accurate documentation for Empagliflozin. These templates include all required elements for proper coding and billing.
Managing Type 2 Diabetes with CKD
Specialty: EndocrinologyRequired Elements
- Patient's A1C levels
- eGFR and UACR results
- Medication adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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