Clin Diabetes. 2017 Oct; 35(4): 232–238. More than 29 million Americans have diabetes. The Centers for Disease Control and Prevention predict that the prevalence of diabetes will increase from 9% to >30% in the next 35 years (1). More than 21 million medical office visits for diabetes are
scheduled each year (2). A total of one in five dollars spent on health care in the United States (and one in three dollars spent through Medicare) are spent on people with diabetes (3). With this in mind, proper and accurate coding for diabetes is a necessity. The
International Classification of Diseases, 10th Revision—Clinical Modification (ICD-10) is designed to accurately classify and categorize all illnesses and diseases seen in the U.S. health care setting. (4) The coding system was updated in October 2015 to its 10th revision because it was thought that the 9th revision (ICD-9) no longer accommodated all of the new codes submitted to the system,
and the ICD-9 codes were not descriptive enough to accurately reflect the state of patients’ diseases. For example, the ICD-9 system had 13,000 three- to five-digit codes. This system was not able to take in new codes and did not include a way to designate laterality. The ICD-10 system has 68,000 codes that are three to seven digits each and has the capacity to expand. In general, ICD-10 codes can be up to seven characters long and are designed as follows: XXX.XXX.X
(category.anatomic site/severity.extension). The first set of digits before the first decimal point describes the general disease or category. The next three digits after the first decimal point describe the etiology, anatomical site, severity, or clinical detail. Finally, some conditions will have a second decimal point, followed by a final digit that may define an initial or subsequent encounter, the laterality of a condition, or the number of weeks’ gestation (in the case of pregnancy). This
may seem overly detailed, but it allows for greater specificity of the disease and its state. Most codes for diabetes will require four or five digits to provide the level of detail required by ICD-10 (5). This article provides key updates for ICD-10 coding for diabetes and its complications. To make sense of the coding descriptions, the authors will explain them based on the way one
might approach diabetes clinically. For proper coding of diabetes, ICD-10 codes should reflect the type of diabetes, its current status, and comorbidities of the disease. Compared to ICD-9, the ICD-10 codes are much more specific. Carefully choosing the most specific ICD-10 codes is important to ensure proper reimbursement. If a person has risk factors for diabetes and you want to screen him or her for the condition (via glucose measurement, oral glucose tolerance test [OGTT], or A1C test), you would use a Z code (which indicates screening or prevention services). Alternatively, using a code that indicates the presence of a risk factor for diabetes is also acceptable for reimbursement. The current acceptable risk factors
include hypertension (I10) and obesity (E66.XX). If a person has prediabetes, the recommended ICD-10 code for abnormal glucose is R73.09, but this code also covers abnormal fasting glucose, abnormal glucose tolerance, or an elevated A1C in the prediabetes range (Table
1). Diagnostic Criteria for Prediabetes* and Diabetes
Codes for Known DiabetesWhen you are treating a person who has known diabetes, the first level of distinction is the type of diabetes. Under ICD-9, the main types of diabetes were coded 250.XX. To properly code for diabetes under ICD-10, four to five digits are needed. The following steps will help to ensure accurate diabetes coding. Step 1. Confirm the Type of DiabetesThe current codes for common forms of diabetes are:
There are a number of special categories of diabetes that have a different pathogenesis from what is known for type 1 and type 2 diabetes. These are collectively called “secondary diabetes” and should not be confused with type 2 diabetes. For secondary diabetes, use the following codes:
Step 2. Describe Whether the Person’s Diabetes Is Currently Well ControlledLevel of control is indicated by the number after the decimal point. If a person’s diabetes is well controlled, that digit will be 9 (i.e., EXX.9). For example, a person with type 2 diabetes that is well controlled who has no complications would be indicated by the code E11.9. Likewise, a person with type 1 diabetes that is well controlled who has no complications would be indicated by the code E10.9. It is important to remember that E11.9 actually describes only a minority of people with type 2 diabetes. One of the goals of ICD-10 is to better characterize the control of people with diabetes and the specifics of the complications that they are experiencing. However, many patients with diabetes have hyperglycemia, which is considered a complication. Therefore, a diagnosis code with a complication code is appropriate for the majority of people with diabetes. All of the digits beyond the decimal point are the same regardless of the type of diabetes (e.g., type 1 vs. type 2 diabetes). Each numerical code after the decimal point (numbers 1–8) describes a different complication. The second and third digit after the decimal point subcategorize that complication. For example, the most common code used for type 2 diabetes is E11.65 (type 2 diabetes with hyperglycemia), which reflects suboptimal control. The most common codes for type 1 diabetes are E10.65 (type 1 diabetes with hyperglycemia) and E10.649 (type 1 diabetes with hypoglycemia without coma). Step 3. For Diabetes That Is Not Well Controlled, Identify Any ComplicationsThe first digit after the decimal point describes both the level of metabolic control and the presence of complications. Further digits subcategorize the complications. As mentioned above, the number 9 after the decimal point (i.e., E10.9 or E11.9) both defines the diabetes as controlled (i.e., without hyperglycemia or hypoglycemia) and documents the absence of complications. Thus, using a 9 after the decimal point should be the exception rather than the rule, given that most people with diabetes have either suboptimal control, complications, or both. The following codes pertain to complications of type 2 diabetes:
More detailed codes further subcategorize complications. Table 2 provides ICD-10 codes for complications associated with type 1 diabetes; Table 3 lists codes for complications associated with type 2 diabetes. TABLE 2.Codes for Type 1 Diabetes With Complications
TABLE 3.Codes for Type 2 Diabetes With Complications
Step 4. Describe Any Identified ComplicationThis means you will use a primary diabetes code that describes the type of diabetes, then specify whether it is controlled and whether there is a complication, and then add a second code specific to that complication. Sample codes for complications of diabetes are shown in Table 4; codes for common comorbidities are shown in Table 5. TABLE 4.Codes for Secondary Diagnosis for Diseases Associated With Diabetes
TABLE 5.Codes for Common Comorbid Disease Conditions
Example 1A patient has type 2 diabetes with polyneuropathy, hypertension with albuminuria, and dyslipidemia. The coding to document this patient should be E11.65 (type 2 diabetes with hyperglycemia), E11.42 (type 2 diabetes with polyneuropathy), I10 (hypertension), R80.9 (microalbuminuria), and E78.2 (mixed hyperlipidemia). Example 2A patient with type 1 diabetes has an active foot ulcer on the bottom of his right foot. The coding to document this patient should be E10.621 (type 1 diabetes with foot ulcer) and L97.411 (non-pressure chronic ulcer of right heel and mid-foot limited to breakdown of skin). Comorbid conditions affect the complexity of care and the treatments you choose and thus should be coded as diagnoses. One nice feature of the BMI coding shown in Table 5 is that all BMI codes start with Z68, and the digits after the decimal are the actual BMI rounded down to the whole number. In the authors’ experience, coding obesity to the level of the BMI has improved the ability to get coverage for additional medications. This suggests that some insurers may be relying on the coding to make coverage decisions. Codes to Document Complexity of Care ProvidedFinally, there are codes that demonstrate the additional work you do or the additional complexity of the care you are providing. These codes help to justify this higher level of care.
After these T codes, there should be a modifier at the end to denote initial encounter (A), subsequent encounter (D), or sequalae (S). For example, an initial encounter for intentional self-harm by overdosing insulin should be “T38.3X2A.” Codes for Pregnancy in DiabetesCodes to report pregnancy in women with diabetes include:
ConclusionRemember the following steps when coding for patients with diabetes:
Box 1 offers two case studies to help you apply your knowledge of diabetes coding. Box 2 provides information about additional tools to help providers with ICD-10 coding. BOX 1. Case Studies for Diabetes Coding
BOX 2. Tools to Help Providers With ICD-10 Coding
Duality of InterestJ.S. serves as an associate editor for Clinical Diabetes. No other potential conflicts of interest relevant to this article were reported. References3. American Diabetes Association Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033–1046 [PMC free article] [PubMed] [Google Scholar] 5. Hodorowicz MA. New ICD-10-CM coding system: a review of the basics. AADE in Practice 2016;4:12–15 [Google Scholar] Articles from Clinical Diabetes : A Publication of the American Diabetes Association are provided here courtesy of American Diabetes Association Do you code insulin pump with type 1 diabetes?Type I diabetics require the use of insulin to live. The use of insulin is implied in the diagnosis of Type I diabetes itself. Since this is the case, it is not necessary to report a Z code for long-term insulin use because it would be understood that this patient would be using insulin.
What is the ICDICD-10 code Z96. 41 for Presence of insulin pump (external) (internal) is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
What is the ICDICD-10 code E10. 9 for Type 1 diabetes mellitus without complications is a medical classification as listed by WHO under the range - Endocrine, nutritional and metabolic diseases .
How do you code an insulin pump?CPT Code 99091
The Endocrine Society has verified that insulin pump data is considered physiologic data and its review and analysis is covered by this service.
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