ICD-10 Coding for Glycated Hemoglobin(E11.9, R73.09)
Complete ICD-10-CM coding and documentation guide for Glycated Hemoglobin. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Glycated Hemoglobin
E08-E13Primary Range
Diabetes mellitus codes with complications
These codes cover diabetes mellitus and its complications, which are directly related to glycated hemoglobin testing.
Abnormal glucose levels
These codes are used for prediabetes and other abnormal glucose findings, relevant for glycated hemoglobin testing.
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 documenting Type 2 diabetes without any specified complications. |
|
| R73.09 | Other abnormal glucose | Use for patients with prediabetes or other abnormal glucose findings without a confirmed diabetes diagnosis. |
|
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 often should HbA1c be tested?
Essential facts and insights about Glycated Hemoglobin
Primary ICD-10-CM Codes for physician's initials glycated
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%
- Symptoms of diabetes (e.g., polyuria, polydipsia)
Code-Specific Risks
- Risk of undercoding if complications are present but not documented.
Coding Notes
- Ensure to document any complications separately to avoid undercoding.
R73.09 - Other abnormal glucose
Use for patients with prediabetes or other abnormal glucose findings without a confirmed diabetes diagnosis.
Applicable To
- Prediabetes
Excludes
- Diabetes mellitus (E08-E13)
Clinical Validation Requirements
- HbA1c 5.7–6.4% on two separate occasions
Coding Notes
Ensure documentation supports the absence of a confirmed diabetes diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.84Differential 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 Glycated Hemoglobin 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 inadequate treatment planning., Regulatory: Increases risk of audit failures., Financial: Potential for claim denials.
Mitigation Strategy
Use specific ICD-10 codes for each complication., Document the relationship to diabetes clearly.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Increases risk of audit due to vague coding., Data Quality: Impacts data accuracy for patient care and research.
Mitigation Strategy
Document and code all complications explicitly.
Impact
Failure to document and code complications accurately.
Mitigation Strategy
Implement regular training on diabetes coding updates.
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 Glycated Hemoglobin, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Glycated Hemoglobin
Use these documentation templates to ensure complete and accurate documentation for Glycated Hemoglobin. These templates include all required elements for proper coding and billing.
Uncontrolled Type 2 Diabetes
Specialty: EndocrinologyRequired Elements
- HbA1c value
- Current treatment plan
- Complications if present
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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