Diabetes Mellitus in ICD‐10‐CM
The diabetes mellitus codes are expanded in ICD‐10‐CM. The codes for diabetes mellitus are located in chapter 4, Endocrine, Nutritional, and Metabolic Diseases, in ICD‐10‐CM. Unlike ICD‐9‐CM, the codes in ICD‐10‐CM for diabetes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications of that body system. There are five categories for diabetes codes in ICD‐10‐CM:
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
As many codes as needed to identify all of the associated conditions of the patients should be assigned.
The terms “uncontrolled” and “not stated as uncontrolled” are no longer used in ICD‐10‐ CM. Instead the codes descriptors indicate “with complications” or without complications.”
The subcategories for the complications with the body systems affected by diabetes mellitus are as follows:
o Without coma
o With coma
o Diabetic nephropathy
o Diabetic chronic kidney disease
o Other diabetic kidney complications
o Diabetic retinopathy
- Mild nonproliferative with/without macular edema
- Moderate nonproliferative with/without macular edema
- Severe nonproliferative with/without macular edema
- Proliferative with/without macular edema
o Diabetic cataract
o Other diabetic ophthalmic complications
- Neurological complications
o Diabetic neuropathy
- Diabetic mononeuropathy
- Diabetic polyneuropathy
- Diabetic autonomic (poly)neuropathy
o Diabetic amyotrophy
o Other diabetic neurological complications
- Circulatory complications
o Diabetic peripheral angiopathy with/without gangrene
o Other circulatory complications
- Other specified complications
o Diabetic arthropathy
- Diabetic neuropathic arthropathy
- Other diabetic arthropathy
o Skin complications
- Diabetic dermatitis
- Foot ulcer
- Other skin ulcer
- Other skin complication
o Oral complications
- Periodontal disease
- Other oral complications
o Other specified complication
Important Diabetes Mellitus Guidelines (complete guidelines located in the ICD‐10‐CM code book)
Type of diabetes: 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.
Type of diabetes mellitus not documented: If the type of diabetes mellitus is not documented in the medical record the default is category E11, Type 2 diabetes mellitus.
For example, if the charge ticket states “DM” then code E11.9, Type 2 diabetes mellitus without complications, is the code that must be assigned. It is very important for providers to consistently document the type of diabetes in order to report the proper code(s).
Diabetes mellitus and the use of insulin: If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11‐, Type 2 diabetes mellitus, should be assigned. Code Z79.4, Long‐term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.
A type 2 diabetic patient that has been using Lantus for 3 months to help control his diabetes presents for a recheck. After history and examination, it is decided to have the patient continue to use the Lantus and come back in 3 months. An A1c will be performed before the next visit.
E11.9 Type 2 diabetes mellitus without complications Z79.4 Long‐term (current) use of insulin
In the Table of Drugs and Chemicals in ICD‐10‐CM, a new column has been added for underdosing of medications. This has lead to new guidelines regarding insulin pump malfunction.
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.
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).
A type 1 diabetic patient is brought in the emergency department with an insulin pump breakdown, resulting in an underdose of insulin. The patient is now has diabetic ketoacidosis with coma.
T85.614A Breakdown (mechanical) of insulin pump, initial encounter
T38.3X6A Underdosing of insulin and oral hypoglycemic (antidiabetic) drugs, initial encounter
E10.11 Type 1 diabetes mellitus with ketoacidosis with coma
A type 1 diabetic patient is brought in to the emergency department with an insulin pump breakdown, resulting in an accidental overdosing of insulin. The patient is now in a hypoglycemic coma.
T85.614A Breakdown (mechanical) of insulin pump, initial encounter T38.3X1A Poisoning by insulin and oral hypoglycemic (antidiabetic) drugs,accidental (unintentional), initial encounter
E10.641 Type 1 diabetes mellitus with hypoglycemia with coma
Secondary diabetes mellitus: Codes under category 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 mellitus is always caused by another condition or event (eg, cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).
Assigning and sequencing secondary diabetes codes and its causes: The sequencing of the secondary diabetes odes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08, E09, and E13.
Secondary diabetes mellitus due to pancreatectomy: For postpancreatectomy diabetes mellitus (lack of insulin due to the surgical removal of all or part of the pancreas), assign code E89.1 Postprocedural hypoinsulinemia. Assign a code from category E13 and a code from subcategory Z90.41‐ Acquired absence of pancreas, as additional codes.
Secondary diabetes due to drugs: Secondary diabetes may be caused by an adverse effect of correctly administered medications, poisoning or sequela of poisoning.
A patient presents for a check up. She developed diabetes after a partial pancreatectomy. She is doing well with no particular complaints.
E89.1 Postprocedural hypoinsulinemia
E13.9 Other specified diabetes mellitus without complications
Z90.411 Acquired partial absence of pancreas