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Diabetes Mellitus ICD-10 Coding Study Guide Published by ICD-10 Coders Academy, LLC

Diabetes Mellitus - ICD-10 Coding

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Diabetes

Text of Diabetes Mellitus - ICD-10 Coding

  • Diabetes Mellitus ICD-10 Coding

    Study Guide

    Published by ICD-10 Coders Academy, LLC

  • CREDITS

    Dr. Meriyala Santosh Kumar Guptha

    CPC, CPC-H, CPC-P, CHA, CPMB, CMBS, CMRS, CHL7

    AHIMA Certified ICD-10 Trainer

    Advisory Council Member (Lead), ICD-10 Coders Academy

  • Universal blue circle symbol for diabetes.

    Diabetes mellitus, often simply referred to as diabetes-is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger).

    Type 1 Diabetes: Results from the bodys failure to produce insulin, and presently requires the person to inject insulin (also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes).

    Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency.

    Type 2 Diabetes: Results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency (formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes).

    Type II diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion.

    A patient with Type II diabetes is always coded as having Type II, even when the medical record states the patient requires insulin.

    Signs and Symptoms: The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger).

    Diabetes Mellitus

  • Diagnosis

    Diabetes mellitus is characterized by recurrent or persistent hyperglycaemia, and is diagnosed by demonstrating any one of the following

    Fasting plasma glucose level 7.0 mmol/L (126 mg/dL)

    Plasma glucose 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.

    Symptoms of hyperglycaemia and casual plasma glucose 11.1 mmol/L (200 mg/dL).

    Glycated haemoglobin (Hb A1C) 6.5%

    Documentation Issues

    Billing and coding will undergo a significant impact with ICD-10-CM implementation. Every area in the healthcare revenue cycle will be impacted. Documentation is of utmost importance. Selection of appropriate code depends upon the documentation.

    If the type of diabetes is not documented in the medical record, the default is to code type II - E11

    Always clarify with the physician about the cause and effect relationship if not documented properly.

    If the documentation indicates that patient has acidosis and diabetes, clarify with physician if there is a cause-and-effect relationship. See the code E87.2 Acidosis has an exclude 1 notes (never be used same time) diabetic acidosis and reference category E08-E13.

    Categories E08, E09, E11 and E13 include a note for assigning code Z79.4 for the long-term use of insulin.

    Type I diabetics require insulin injections to survive.

    Type II diabetics may improve their health with insulin injections, and may even come to require insulin. Administration of insulin has no bearing on code selection for diabetes. Nor the does the age of onset.

    Diabetes codes in ICD-10-CM are combination codes, includes

    Type of diabetes

    Body system involved

    Complication

  • Examples

    E10.311 - Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema

    E10.52 - Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene

    If the type of diabetes is not mentioned in the documentation, query the physician or assign the code E11.

    Assign the code Z79.4 for long term use of insulin

    If insulin is given on temporary basis, dont assign the code Z79.4

    In ICD-10-CM, six categories of Diabetes conditions were described. The codes are specific and stress precise documentation.

    E08 Diabetes mellitus due to underlying condition

    E09 Drug or chemical induced diabetes mellitus

    E10 Type 1 diabetes mellitus

    E11 Type 2 diabetes mellitus

    E13 Other specified diabetes mellitus

    Type-1 Diabetes

    Category-E10 includes

    Brittle diabetes (mellitus)

    Diabetes (mellitus) due to autoimmune process

    Diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction

    Idiopathic diabetes (mellitus)

    Ketosis-prone diabetes (mellitus)

    Juvenile onset diabetes (mellitus)

    Age of the patient is the not the determining factor to assign the code E10

    ICD-10-CM 4a1

    The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason, type 1 diabetes mellitus is also referred to as juvenile diabetes.

  • The following conditions are not included. Cannot be coded with E-10 (Excludes1)

    Diabetes mellitus due to underlying condition (E08.-)

    Drug or chemical induced diabetes mellitus (E09.-)

    Gestational diabetes (O24.4-)

    Hyperglycemia NOS (R73.9)

    Neonatal diabetes mellitus (P70.2)

    Postpancreatectomy diabetes mellitus (E13.-)

    Postprocedural diabetes mellitus (E13.-)

    Secondary diabetes mellitus NEC (E13.-)

    Type 2 diabetes mellitus (E11.-)

    Brittle Diabetes

    Brittle diabetes, also known as unstable diabetes or labile diabetes, refers to a type of insulin-dependent diabetes characterized by dramatic and recurrent swings in glucose levels, often occurring for no apparent reason.

    Juvenile-Onset Diabetes

    Juvenile-onset diabetes usually begins between the age of three to 15 and is sometimes referred to as type one or insulin-dependent diabetes as sufferers of this condition are totally reliant on insulin to survive.

    The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason, type 1 diabetes mellitus is also referred to as juvenile diabetes.

    Ketosis-Prone diabetes

    Severe diabetes mellitus with an early onset; characterized by polyuria and excessive thirst and increased appetite and weight loss and episodic ketoacidosis; diet and insulin injections are required to control the disease.

    E10.21: Type 1 Diabetes Mellitus With Diabetic Nephropathy

    Type 1 diabetes mellitus with intercapillary glomerulosclerosis

    Type 1 diabetes mellitus with intracapillary glomerulonephrosis

    Type 1 diabetes mellitus with Kimmelstiel-Wilson disease

    Intercapillary glomerulosclerosis - A degenerative complication of diabetes, manifested as albuminuria, nephrotic edema, hypertension, renal insufficiency, and retinopathy.

  • Intracapillary glomerulonephrosis - KIDNEY injuries associated with diabetes mellitus and affecting KIDNEY GLOMERULUS; ARTERIOLES; KIDNEY TUBULES; and the interstitium.

    Kimmelstiel-Wilson: Diabetic nephropathy (kidney disease). Kimmelstiel-Wilson disease is a kidney condition associated with long-standing diabetes. It affects the network of tiny blood vessels (the microvasculature) in the glomerulus, a key structure in the kidney that is composed of capillary blood vessels and which is critically necessary for the filtration of the blood.

    Features of Kimmelstiel-Wilson disease include the nephrotic syndrome with excessive filtration of protein into the urine (proteinuria), high blood pressure (hypertension), and progressively impaired kidney function. When severe, Kimmelstiel-Wilson disease leads to kidney failure, end-stage renal disease, and the need for chronic kidney dialysis or a kidney transplant.

    The main sign of diabetic nephropathy is persistent protein in the urine.

    Documentation Tip

    Documentation of Proteinuria

    Type-1 Diabetes Without Complications

    ICD-10-CM has specific code for the type 1 diabetes without any complications.

    E10.62 - Type 1 diabetes mellitus with skin complications

    Atherosclerosis:

    Diabetic atherosclerosis is coded under E10 category. If the diagnosis is diabetes with Ischemic heart disease or cerebrovascular disease, code them as separate entities.

    In ICD-10-CM, diabetes mellitus with skin complications is added. Dermatologists need to document in detail about the cutaneous manifestations.

    Necrobiosis Lipoidica Diabeticorum (NLD)

    NLD is a rash that occurs on the lower legs. It is more common in women, and there are usually several spots. NLD usually occurs more often in people with diabetes, in people with a family history of diabetes or a tendency to get diabetes.

    Oral Complications

    E10.630 - Type 1 diabetes mellitus with periodontal disease

    Periodontal diseases (also called periodontitis) are those diseases that affect one or more of the periodontal tissues:

    1. Alveolar bone

    2. Periodontal ligament

    3. Cementum

    4. Gingiva

  • E10.43 - Type 1 diabetes mellitus with diabetic autonomic (poly) neuropathy

    Type 1 diabetes mellitus with diabetic gastroparesis

    Gastroparesis is a diabetic complication that occurs from neuropathy of the stomach nerve (called the vagus nerve). This causes digestive difficulties as the food starts to move too slowly through the stomach.

    E10.610 - Type 1 diabetes mellitus with diabetic neuropathic arthropathy

    Type 1 diabetes mellitus with Charcts joints

    Neuropathic osteoarthropathy, also known as Charcot joint (Charcot foot) refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious.

    If this pathological process continues unchecked, it could result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst case scenario: amputation or death.

    E11 Type II Diabetes Mellitus

    Includes:

    Diabetes (mellitus) due to insulin secretory defect

    Diabetes NOS

    Insulin resistant diabetes (mellitus)

    Use additional code to identify any insulin use (Z79.4)

    E11.00 - Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

    This occurs when blood sugar rises to very high levels and the body uses urination to try to get rid of the excess glucose, eventually leading to extreme dehydration. NKHS is usually brought on by illness or injury and is characterized by a blood sugar over 600 mg/dL. Without proper treatment, the extreme dehydration will lead to seizures, coma and possibly death.

    E13: Other Specified diabetes mellitus

    Diabetes mellitus due to genetic defects of beta-cell function

    Diabetes mellitus due to genetic defects in insulin action

    Postpancreatectomy diabetes mellitus

    Postprocedural diabetes mellitus

    Secondary diabetes mellitus NEC

    Use additional code to identify any insulin use (Z79.4)

  • Secondary Diabetes:

    Codes under category E08, Diabetes mellitus due to underlying condition, and E09, Drug or chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).

    E08.00: Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotichyperglycemic-hyperosmolar coma (NKHHC)

    E08.01: Diabetes mellitus due to underlying condition with hyperosmolarity with coma

    This occurs when blood sugar rises to very high levels and the body uses urination to try to get rid of the excess glucose, eventually leading to extreme dehydration.

    NKHS is usually brought on by illness or injury and is characterized by a blood sugar over 600 mg/dL. Without proper treatment, the extreme dehydration will lead to seizures, coma, and possibly death.

    ICD-10-CM ICD-9-CM Code

    E0801Diabetes mellitus due to underlying condition with hyperosmolarity with coma

    249.20Secondary diabetes mellitus with hyperosmolarity; not stated as uncontrolled, or unspecified

  • ICD-9-CM Code 249.20 is not an exact match to E08.01.

    ICD-9-CM code 249.20 is also mapped to 2 ICD-10-CM codes

    E08.01: Diabetes mellitus due to underlying condition with hyperosmolarity with coma

    E09.01: Drug or chemical-induced diabetes mellitus with hyperosmolarity with coma

    ICD-10-CM Code

    E08.00 (diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma [NKHHC] is also mapped to 249.20)

    It will be a big challenge for the coders to assign the ICD-10-CM Code based on GEMs.

    CMS clearly states that GEMs should not be used for direct coding. Dont blindly assign the code E08.01 based on GEM Mapping to 249.20.

    ICD-10-CM has been updated to reflect the current clinical understanding and technological advancements of medicine, and the code descriptions are designed to provide a more consistent level of detail. It contains a more extensive vocabulary of clinical concepts, body part specificity, patient encounter information, and other components from which codes are built.

    It is very important for the coder to analyse the documentation and clinical scenario.

    Physician may need document the following to assign the code E08.01.

    Cause for Diabetes Mellitus1)

    Use of Insulin2)

    Level of blood sugar 3)

    Dehydration4)

    Comatose condition5)

    Diabetes Mellitus (due to underlying cause) with hypersomolarity without coma: E08.00

    Diabetes Mellitus (due to underlying cause) with hypersomolarity with come: E08.01

    Diabetes Mellitus (due to underlying cause) with ketoacidosis without come: E08.10

    Diabetes Mellitus (due to underlying cause) with ketoacidosis with coma: E08.11

    Diabetes Mellitus (due to underlying cause) with hypoglycaemia with coma: E08.641

    Diabetes Mellitus (due to underlying cause) with hypoglycaemia without coma: E08.649

  • E08.21:

    Diabetes mellitus due to underlying condition with diabetic nephropathy

    Diabetes mellitus due to underlying condition with intercapillary glomerulosclerosis

    Diabetes mellitus due to underlying condition with intracapillary glomerulonephrosis

    Diabetes mellitus due to underlying condition with Kimmelstiel-Wilson disease

    Other Specified Diabetes Mellitus

    ICD-10-CM has specific codes for the Other Specified Diabetes Mellitus.

    The following are not coded as Other Specified Diabetes

    Diabetes (mellitus) due to autoimmune process (E10.-)

    Diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)

    Diabetes mellitus due to underlying condition (E08.-)

    Drug or chemical induced diabetes mellitus (E09.-)

    Gestational diabetes (O24.4-)

    Neonatal diabetes mellitus (P70.2)

    Type 2 diabetes mellitus (E11.-)

    Any condition listed above is included in E13 category (Secondary Diabetes Mellitus NEC)

    E13.43: Other specified diabetes mellitus with diabetic autonomic (poly) neuropathy

    Other specified diabetes mellitus with diabetic gastroparesis

    Complications due to insulin pump malfunction

    (a) Underdose of insulin due to insulin pump failure

    An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, that specifies the type of pump malfunction, as the principal or first listed code, followed by code T38.3x6-, Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.

    (b) Overdose of insulin due to insulin pump failure

    The principal or first listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be T85.6-, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, followed by code T38.3x1-, Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional).

  • Diabetes mellitus in pregnancy

    Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should be assigned a code O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08-E13)

    Gestational (pregnancy induced) diabetes

    Gestational (pregnancy induced) diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus. It also puts the woman at greater risk of developing diabetes after the pregnancy. Codes for gestational diabetes are in subcategory O24.4, Gestational diabetes mellitus. No other code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, should be used with a code from O24.4 The codes under subcategory O24.4 include diet controlled and insulin controlled. If a patient with gestational diabetes is treated with both diet and insulin, only the code for insulin-controlled is required.

    Code Z79.4, Long-term (current) use of insulin, should not be assigned with codes from subcategory O24.4.

    An abnormal glucose tolerance in pregnancy is assigned a code from subcategory O99.81, Abnormal glucose complicating pregnancy, childbirth, and the puerperium.

    Documentation Issues

    Case #1: The patient was admitted through ED with severe abdominal cramping, Ultrasound showed a complex right lower quadrant mass with free fluid in the pelvis. It was decided to perform a laparoscopy for the possibility of an ectopic pregnancy. The patient has pre-existing diabetes mellitus, type I.

    In the above case, Trimester of Pregnancy is not mentioned to assign code from category O24 (Diabetes mellitus in pregnancy, childbirth, and the puerperium)

    One of the key specific Chapter 15 ICD-10-CM guidelines includes the final character for the trimester. To code appropriately as per ICD-10, documentation of exact weeks and days is necessary.

    Trimesters are defined as follows:

    1st trimester less than 14 weeks 0 days

    2nd trimester 14 weeks 0 days to less than 28 weeks 0 days

    3rd trimester 28 weeks 0 days until delivery

  • Case #2: A patient is admitted with chronic kidney disease, stage 4 for dialysis. Patient is Type II diabetic controlled by insulin.

    Z49.31: Encounter for adequacy testing for hemodialysis . Type 2 diabetes mellitus without complications

    E11.9: Type 2 diabetes mellitus without complications

    N18.4: Chronic kidney disease, stage 4 (severe)

    Z79.4: Long term (current) use of insulin

    Case #3: A 60-year-old female is seen in the clinic for her neurogenic bladder disorder secondary to diabetes. Patient is Type II diabetic, controlled by insulin.

    E11.40: Type 2 diabetes mellituswith diabetic neuropathy, unspecified

    N13.9: Obstructive and reflux uropathy, unspecified

    Z79.4: Long term (current) use of insulin

    Case #4: A 56-year-old male was presented to ED with coma. Blood workup revealed hypoglycemia.

    E10.641: Type 1 diabetes mellitus with hypoglycemia with coma

    Case #5: A 43-year-old is admitted with diabetic ketoacidosis with coma. Patient history identifies a previous history of pancreatomy.

    E89.1 (postsurgical hypoinsulinemia)

    E08.11 (diabetes mellitus due to underlying condition with ketoacidosis with coma)

    Z79.4 (acquired absence organ)

    Case #6: A Type I diabetic male is seen in the clinic with hypoglycemia. Physician identifies that patient has been compliant with antidiabetic drugs.

    E10.65: Type 1 diabetes mellitus with hyperglycemia

    T383X5A: Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs

  • Notes