ICD-10-CM: Diabetes Mellitus

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May 27, 2015Vol. 13

ICD-10-CM IndexDiabetes, diabetic (mellitus) (sugar) E11.9- type 2 E11.9-- with- - - foot ulcer E11.621

ICD-10-CM TabularE11 Type 2 diabetes mellitus Use additional code to identify any insulin use (Z79.4) E11.6 Type 2 diabetes mellitus with other specified complications E11.62 Type 2 diabetes mellitus with skin complications E11.621 Type 2 diabetes mellitus with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-)

ICD-10-CM TabularL97 Non-pressure chronic ulcer of lower limb, not elsewhere classified L97.4 Non-pressure chronic ulcer of heel and midfoot L97.42 Non-pressure chronic ulcer of left heel and midfoot L97.422 Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed

ICD-10-CM IndexUlcer, ulcerated, ulcerating, ulceration, ulcerative- foot (indolent) (trophic) —see Ulcer, lower limb- lower limb (atrophic) (chronic) (neurogenic) (perforating) (pyogenic) (trophic) (tropical) L97.909- - midfoot L97.409- - - left L97.429- - - - with- - - - - exposed fat layer L97.422

ICD-10-CM TabularE11 Type 2 diabetes mellitus Use additional code to identify any insulin use (Z79.4) E11.5 Type 2 diabetes mellitus with circulatory complications E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene

ICD-10-CM IndexDiabetes, diabetic (mellitus) (sugar) E11.9- type 2 E11.9-- with- - - peripheral angiopathy E11.51

1. B) Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer L97.422

1. Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer E11.621

2. Diabetic peripheral angiopathy E11.51

3. Diabetic stage 2 chronic kidney disease E11.22

What is diabetes?

A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should. NIH - National Cancer Institute

Diabetes is mainly found in Chapter 4: Endocrine, Nutritional, and Metabolic Diseases, of ICD-10-CM

• Exception is when complicating pregnancy, childbirth and the puerperium (O24)

• Additional code(s) from E08-E13 are assigned to identify any manifestations

In ICD-10-CM there are five updated Diabetes Mellitus categories to reflect the current clinical classification and manifestations:

• E08 Diabetes Mellitus due to an underlying condition • E09 Drug or chemical induced diabetes mellitus • E10 Type 1 diabetes mellitus • E11 Type 2 diabetes mellitus • E13 Other specified diabetes mellitus • Note: No longer use controlled and uncontrolled. The new system now classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia.

Type 1 Diabetes, E10 (O24.0 in Pregnancy, Childbirth, and the Puerperium)

• The body does not produce insulin. • Some people may refer to this type as insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes. • People usually develop type 1 diabetes before their 40th year, often in early adulthood or teenage years. • Approximately 10% of all diabetes cases are type 1. • Patients with type 1 diabetes will need to take insulin injections for the rest of their life.

Type 2 Diabetes, E11 (O24.1 in Pregnancy, Childbirth, and the Puerperium)

• The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (insulin resistance). • Approximately 90% of all cases of diabetes worldwide are of this type. • Some people may be able to control their type 2 diabetes symptoms by losing weight, following a healthy diet, doing plenty of exercise, and monitoring their blood glucose levels. • However, type 2 diabetes is typically a progressive disease - it gradually gets worse - and the patient will probably end up have to take insulin, usually in tablet form.

Gestational Diabetes – Found in Chapter 15: Pregnancy, Childbirth, and the Puerperium, O24.4_

• This type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. • Diagnosis of gestational diabetes is made during pregnancy. • The majority of gestational diabetes patients can control their diabetes with exercise and diet. • Between 10% to 20% of them will need to take some kind of blood-glucose-controlling medications. • Undiagnosed or uncontrolled gestational diabetes can raise the risk of complications during childbirth. The baby may be bigger than he/she should be.

ICD-10-CM Official Guidelines for Coding and Reporting FY 2015 I, C, 4, a, 6), Secondary diabetes mellitus

• Codes under categories E08, Diabetes mellitus due to underlying condition, E09, Drug or chemical induced diabetes mellitus, and E13, Other specified 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).

Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that include • The type of DM, the body system affected, and the complication affecting that body system as part of the code description. • Subcategory levels first specify the type of complication by system, such as diabetes with kidney complications, ophthalmic complications, neurological complications, and circulatory complications. • The subclassification level then describes the particular manifestation.Example:

E10 Type 1 diabetes mellitus E10.2 Type 1 diabetes mellitus with kidney complications E10.21 Type 1 diabetes mellitus with diabetic nephropathy

Coders should know:

• Use as many codes as are needed to describe all of the associated complications that the patient has from a particular category. • Because of this code structure, there is no instructional note found under diabetes mellitus codes in ICD-10-CM requiring an additional code to identify the manifestation since it is already part of the code description. • There are specific diabetes codes that do require additional codes in order to identify the manifestation further, such as diabetes with foot ulcer to identify the site of the ulcer, or diabetes with chronic kidney disease to identify the stage of chronic kidney disease. • For example, the code E10.22 ( Type 1 diabetes mellitus with chronic kidney disease) requires the use of an additional code to identify the stage of chronic kidney disease (N18.1-N18.6)

Physicians should document whether the diabetes is:

• Type 1, • Type 2, • Drug- or chemical-induced, • Due to an underlying condition. • The specific underlying condition, • The specific drug or toxin, • The use of any insulin

Coding practice: Code Diagnostic codes onlyScenario: This insulin dependent type 2 diabetic patient has a severe chronic diabetic foot ulcer of the left midfoot, with exposed fat layer, with diabetic peripheral angiopathy. He also has diabetic stage 2 chronic kidney disease, and diabetic gastroparesis. He is being evaluated for possible surgical intervention of his foot ulcer.

• What should be coded in this example?

1. Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer 2. Diabetic peripheral angiopathy 3. Diabetic stage 2 chronic kidney disease 4. Diabetic gastroparesis 5. Long term insulin use

ICD-10-CM TabularE11 Type 2 diabetes mellitus Use additional code to identify any insulin use (Z79.4) E11.2 Type 2 diabetes mellitus with kidney complications E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease Use additional code to identify stage of chronic kidney disease (N18.1-N18.6)

ICD-10-CM IndexDiabetes, diabetic (mellitus) (sugar) E11.9- type 2 E11.9-- with- - - chronic kidney disease E11.22

ICD-10-CM TabularN18 Chronic kidney disease (CKD) Code first any associated: diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22) hypertensive chronic kidney disease (I12.-, I13.-) Use additional code to identify kidney transplant status, if applicable, (Z94.0) N18.2 Chronic kidney disease, stage 2 (mild)

ICD-10-CM TabularE11 Type 2 diabetes mellitus Use additional code to identify any insulin use (Z79.4) E11.4 Type 2 diabetes mellitus with neurological complications E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy Type 2 diabetes mellitus with diabetic gastroparesis

ICD-10-CM Tabular

Z79 Long term (current) drug therapy Z79.4 Long term (current) use of insulin

ICD-10-CM IndexDiabetes, diabetic (mellitus) (sugar) E11.9- type 2 E11.9-- with- - - gastroparesis E11.43

ICD-10-CM IndexLong-term (current) (prophylactic) drug therapy (use of)- insulin Z79.4

ICD-10-CM IndexDisease, diseased —see also Syndrome- kidney (functional) (pelvis) N28.9-- chronic N18.9- - - stage 2 (mild) N18.2

3. B) Diabetic stage 2 chronic kidney disease N18.2

4. Diabetic gastroparesis E11.43

5. Long term insulin use Z79.4

Final diagnostic codes:

1. Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer E11.621

1. B) Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer L97.422

2. Diabetic peripheral angiopathy E11.51 3. Diabetic stage 2 chronic kidney disease E11.22 3. B) Diabetic stage 2 chronic kidney disease N18.2 4. Diabetic gastroparesis E11.43 5. Long term insulin use Z79.4