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ICD-10-CM-2017 Diabetes Coding Guide-MEDESUN-Dr Guptha 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 body's 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. With DKA, the diagnosis of “diabetes” defaults to Type I, since most diabetics who develop DKA are Type I diabetics. DKA occurs when a shortage of insulin causes the body to break down fat and muscle for energy. The byproduct of this process is ketones, which enter the bloodstream and cause a dangerous form of acidosis. In DKA, the patient is severely dehydrated and confused. Due to the electrolyte imbalance caused by DKA, hospitalization is required to stabilize the blood chemistry and restore hydration. 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 adultonset diabetes.) Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. Signs and Symptoms: The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). Type I diabetics are always insulin dependent. Type II diabetics can often control their blood sugars with a combination of diet, exercise, and oral medication. Some Type II diabetics cannot control their blood sugars except through insulin injections. More details in Medical Coding Training Program.
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Diagnosis Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, 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 hyperglycemia and casual plasma glucose ≥ 11.1 mmol/L (200 mg/dL). Glycated hemoglobin (Hb A1C) ≥ 6.5%
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Diabetes codes in ICD-10-CM are combination codes, includes Type of diabetes Body System Involved Complication Example: 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, don’t assign the code Z79.4
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ICD-10-CM 2017 The first major change in ICD-10-CM codes for 2017 is for diabetic ocular complication coding. All of the DM retinopathy code choices will now specify which eye is impacted. Several new codes for proliferative diabetic retinopathy were also added. Laterality is now a component of all diabetic retinopathy and macular edema codes. For patients who routinely use insulin or hypoglycaemic drugs, code Z79.4, Long-term (current) use of insulin, or Z79.84, Long term (current) use of oral hypoglycemic drugs should also be assigned. If a patient is on both oral medication and insulin, both of these medication codes should be used E10.32 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy Type 1 diabetes mellitus with nonproliferative diabetic retinopathy NOS One of the following 7th characters is to be assigned to codes in subcategory E10.32 to designate laterality of the disease: 1 - right eye 2 - left eye 3 - bilateral 9 - unspecified eye With implementation of 2017 ICD-10, coding diabetic patients with ophthalmic manifestations frequently requires a seventh digit to indicate which eye is involved. For example, E11.34 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy One of the following 7th characters is to be assigned to codes in subcategory E11.34 to designate laterality of the disease: 1 = right eye 2 = left eye 3 = bilateral Medesun Global-Medical Coding Training-copyrights@Medesun Phone-09966933693
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9 = unspecified eye E11.341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy, with macular edema E11.349 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy, without macular edema You will also note that ICD-10 codes E11.35 used for Type 2 diabetes mellitus with proliferative diabetic retinopathy (E11.351 = with macular edema; E35.359 = without edema) has been greatly expanded. E11.35 Type 2 diabetes mellitus with proliferative diabetic retinopathy One of the following 7th characters is to be assigned to code E11.35 1 = right eye 2 = left eye 3 = bilateral 9 = unspecified eye E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E11.352 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula E11.353 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula E11.354 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment E11.355 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy E11.359 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema In addition, there are new codes for Type 2 diabetes with diabetic macular edema, resolved following treatment.
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E11.37 Type 2 Diabetes mellitus with diabetic macular edema, resolved following treatment One of the following 7th characters is to be assigned to code E11.37 1 = right eye 2 = left eye 3 = bilateral 9 = unspecified eye Secondary Diabetes 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). In ICD-10-CM, 5 categories of Diabetes conditions were described. The codes are specific and stresses precise documentation. Medesun Global-Medical Coding Training-copyrights@Medesun Phone-09966933693
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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)
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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.
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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 E10.2: 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. 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 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.
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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. E10.610Type 1 diabetes mellitus with diabetic neuropathic arthropathy Type 1 diabetes mellitus with Charcôt's joints Neuropathic osteoarthropathy, also known as Charcot joint (often "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.
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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.
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Without proper treatment, the extreme dehydration will lead to seizures, coma and possibly death. E11: 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 Medesun Global-Medical Coding Training-copyrights@Medesun Phone-09966933693
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Secondary diabetes mellitus NEC Use additional code to identify any insulin use (Z79.4) or Z79.84, Long term (current) use of oral hypoglycemic drugs The ICD-10-CM tabular listing for each of the following subcategories will require the following 7th character to be added as indicated by this statement under each subcategory: E11.32, E11.33, E11.34, and E11.35. As an example, all of the nonproliferative diabetic retinopathy codes are included for the use of this 7th character similar to the E11.32 code: E11.32 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy Type 2 diabetes mellitus with nonproliferative diabetic retinopathy NOS. The 7th characters to be assigned to codes in subcategory E11.32 are: 1 - right eye 2 - left eye 3 - bilateral 9 - unspecified eye E11.321 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema E11.329 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema If each eye has a different level of retinopathy, the provider will need two codes. For example, in a patient with mild retinopathy without macular edema in the right eye and severe retinopathy without macular edema in the left eye, the following codes would be used: E11.3211 and E11.3412
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There are several changes to the proliferative diabetic retinopathy codes for 2017. The subcategories are as follows and all are eye specific using the 7th character added to the codes. E11.351 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema E11.352 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula E11.353 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula E11.37 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment 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 Medesun Global-Medical Coding Training-copyrights@Medesun Phone-09966933693
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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.
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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 1) Cause for Diabetes Mellitus 2) Use of Insulin 3) Level of blood sugar 4) Dehydration 5) Comatose condition Diabetes Mellitus (Due to underlying cause) with hypersomolarity without coma: E08.0 DiabetesMellitus (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
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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 Prediabetes (R73.03) Prediabetes was previously classified to R73.09 Other abnormal glucose. The new code R73.03 uniquely identifies patients with prediabetes so that this condition can be tracked. The American Diabetes Association® defines prediabetes as one of the following abnormalities when blood glucose or A1c level is tested: • An impaired fasting glucose (IFG) • Fasting blood glucose of 100-125mg/dL • Impaired glucose tolerance (IGT) • Blood glucose of 140-199mg/dL 2 hours after a 75g oral glucose tolerance test (OGTT) • A hemoglobin A1c (A1c) value of 5.7-6.4%
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