ICD-10 Coding for Hemoglobin A1c(R73.09, E11.65)
Complete ICD-10-CM coding and documentation guide for Hemoglobin A1c. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hemoglobin A1c
R73-R73.9Primary Range
Abnormal glucose levels
Includes codes for prediabetes and other abnormal glucose findings.
Encounter for screening for other diseases and disorders
Used for screening encounters, such as diabetes screening.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R73.09 | Other abnormal glucose | Use for patients with prediabetes based on HbA1c results. |
|
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Use when HbA1c indicates uncontrolled diabetes with hyperglycemia. |
|
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 HbA1c
Essential facts and insights about Hemoglobin A1c
Primary ICD-10-CM Codes for haemoglobin-a1c
Decision Criteria
clinical Criteria
- HbA1c between 5.7% and 6.4%
Applicable To
- Prediabetes
Excludes
- Diabetes mellitus (E11-E11.9)
Clinical Validation Requirements
- HbA1c between 5.7% and 6.4% without a prior diabetes diagnosis
Code-Specific Risks
- Misclassification if diabetes is present.
Coding Notes
- Ensure HbA1c results are documented clearly.
E11.65 - Type 2 diabetes mellitus with hyperglycemia
Use when HbA1c indicates uncontrolled diabetes with hyperglycemia.
Applicable To
- Uncontrolled diabetes with hyperglycemia
Excludes
- Prediabetes (R73.09)
Clinical Validation Requirements
- HbA1c >9.0% with documented hyperglycemia
Coding Notes
Document hyperglycemia and HbA1c levels accurately.
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 Hemoglobin A1c to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R73.09.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use specific terms like 'Type 2 DM with hyperglycemia'.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use R73.09 only for prediabetes; use E11.xx for confirmed diabetes.
Impact
Testing HbA1c more than 4 times a year without justification.
Mitigation Strategy
Document medical necessity for frequent testing.
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 Hemoglobin A1c, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hemoglobin A1c
Use these documentation templates to ensure complete and accurate documentation for Hemoglobin A1c. These templates include all required elements for proper coding and billing.
Diabetes monitoring
Specialty: EndocrinologyRequired Elements
- Patient information
- Test date
- HbA1c percentage
- Reference ranges
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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