Best Practices for Coding Diabetes

  • June 7, 2018

    With the implementation of ICD-10-CM and coding classification changes, there are now combination codes for diabetes and its associated conditions.

    It’s essential that medical records provide specific details on all diabetes-related conditions. Specific coding ensures that you’re accurately reflecting your patients’ health and supports your reimbursement.

    When reviewing Diabetes Mellitus (DM) with patients, remember to document and code the following:

    1. Type 1 (E10.-)
      • Type 2 (E11.-)
      • Due to underlying condition (E08.-)
      • Drug or chemical induced (E09.-)
      • Other Specified (E13.-)
      • Gestational Diabetes (O24.-)
    2. Cause
      • Clearly document the cause of diabetes if applicable
    3. Complications
      • Indicate the conditions complicating diabetes to the highest specificity
        • Example: Type 2 DM with kidney complications, CKD 4
      • If a patient has multiple complications, select a code from Diabetes section for each complication
        • Scenario: A patient has type 2 DM with neuropathy, nephropathy and right heel ulcer (with necrosis of muscle) complications.
        • Codes:
          • E11.40 Type 2 DM with diabetic neuropathy, unspecified
          • E11.21 Type 2 DM with diabetic nephropathy
          • E11.621 Type 2 DM with foot ulcer
          • L97.413 Non-pressure chronic ulcer of right heel with necrosis of muscle
        • Indicate hyperglycemia or hypoglycemia when DM is uncontrolled
          • There is no code for “uncontrolled” in ICD-10

    Review the Premera Documentation and Coding Series for Practitioners. For documentation and coding training or if you have any questions, email ProviderClinical Consulting@Premera.com.

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