ICD-10 Coding for Uncontrolled Diabetes Mellitus(E11.65, E11.641, E11.9)
Complete ICD-10-CM coding and documentation guide for Uncontrolled Diabetes Mellitus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Uncontrolled Diabetes Mellitus
E11.65-E11.649Primary Range
Type 2 diabetes mellitus with hyperglycemia or hypoglycemia
This range covers uncontrolled diabetes with specified hyperglycemia or hypoglycemia.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | When hyperglycemia is documented with type 2 DM. |
|
| E11.641 | Type 2 diabetes mellitus with hypoglycemia | When hypoglycemia is documented with type 2 DM. |
|
| E11.9 | Type 2 diabetes mellitus without complications | When diabetes is stable or unspecified. |
|
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 uncontrolled diabetes
Essential facts and insights about Uncontrolled Diabetes Mellitus
Primary ICD-10-CM Codes for uncontrolled initials of a doctor
Decision Criteria
documentation Criteria
- Hyperglycemia must be explicitly linked to diabetes.
Applicable To
- Uncontrolled type 2 DM with hyperglycemia
Excludes
- Type 1 diabetes mellitus with hyperglycemia
Clinical Validation Requirements
- Fasting glucose >130 mg/dL
- Random glucose >200 mg/dL
- HbA1c >9%
Code-Specific Risks
- Incorrect use without documented hyperglycemia
Coding Notes
- Ensure hyperglycemia is explicitly documented.
E11.641 - Type 2 diabetes mellitus with hypoglycemia
When hypoglycemia is documented with type 2 DM.
Applicable To
- Uncontrolled type 2 DM with hypoglycemia
Excludes
- Type 1 diabetes mellitus with hypoglycemia
Clinical Validation Requirements
- Blood glucose <70 mg/dL with symptoms
Coding Notes
Ensure hypoglycemia is explicitly documented.
E11.9 - Type 2 diabetes mellitus without complications
When diabetes is stable or unspecified.
Applicable To
- Stable glucose levels
Excludes
- Type 2 diabetes mellitus with hyperglycemia
- Type 2 diabetes mellitus with hypoglycemia
Clinical Validation Requirements
- No acute hyperglycemia or hypoglycemia documented
Coding Notes
Use when no complications or uncontrolled status is specified.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Type 2 diabetes mellitus with foot ulcer
E11.621Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Type 2 diabetes mellitus without complications
E11.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Uncontrolled Diabetes Mellitus 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 inadequate treatment adjustments., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Educate providers on documentation requirements., Implement EHR prompts for specificity.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query provider for specification of hyperglycemia.
Impact
Lack of specificity in documenting uncontrolled diabetes.
Mitigation Strategy
Implement provider education and EHR prompts.
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 Uncontrolled Diabetes Mellitus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Uncontrolled Diabetes Mellitus
Use these documentation templates to ensure complete and accurate documentation for Uncontrolled Diabetes Mellitus. These templates include all required elements for proper coding and billing.
Endocrinology Clinic Visit
Specialty: EndocrinologyRequired Elements
- Type of diabetes
- Control status
- Complications
- Treatment adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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