ICD 10 CM CODING - DIABETES

Anand K CPC, CRC

 Disclaimer

This presentation is designed to offer basic information for coding

and billing. The information presented here is based on the
experience, training and interpretation of the author. Although the
information has been carefully researched and checked for
accuracy and completeness, the instructor does not accept any
responsibility or liability with regard to errors, omissions, misuse
or misinterpretation. This material is intended as an Educational
guide and should not be considered a legal/consulting opinion.
 Introduction

What comes in mind when you think of Diabetes????

 Learning Objectives
By the end of this seminar, you will get an insight on…….

S.No Topic
1 Introduction
2 Anatomy of Pancreas
3 Pathophysiology of Diabetes Mellitus
4 Function and work of insulin
5 ICD Guidelines for coding insulin
6 ICD Guidelines for insulin pump malfunction
7 Types of Diabetes Mellitus
8 Signs and symptoms of Diabetes
9 Diabetic Risk factors
10 Management and prevention of Diabetes
11 Diabetic complications (acute and chronic)
12 Scenarios
 Introduction - What is Diabetes?

• Diabetes is a disease that affects how you body handles sugar (glucose)

• A metabolic disease in which the body’s inability to produce any or enough insulin causes elevated
levels of glucose in the blood”
 Anatomy of Pancreas
The pancreas lies transversely in the upper abdomen between the duodenum on the right and the spleen
on the left. It is divided into the head, neck, body, and tail

I function both Exocrine and Endocrine!!!!!

 Function of Pancreas

Secretes digestive
Exocrine enzymes (Lipase,
Amylase, protease)
Pancreas
Produces and secretes
hormones into blood
Endocrine
stream (Islets of
Langerhans)

Islets of Langerhans

Beta cells
Alpha cells Delta cells
(produces Insulin)
 Function and work of Insulin

How does Insulin work?

-Insulin is responsible for regulating blood glucose levels in the body by allowing the movement of
glucose into cells.

-Insulin is continuously released by the pancreatic beta cells at a low level throughout the day, which
helps to:

•Maintain the resting blood glucose levels at a healthy range between eating and during the night.

•Allow constant low-level uptake of glucose into cells for cellular processes, such as cellular growth and
DNA replication.
 Pathophysiology - General
Diabetes is either due to pancreas not producing enough insulin or the cells of the body not properly
responding to the insulin produced

There are different types of Diabetes Mellitus

 Types of Diabetes Mellitus
Diabetes
Mellitus

Type 1 Type 1.5 DM

(IDDM)

Type 2 • LADA
(NIDDM) • Double Diabetes
• Slowly Progressing Type 1 DM (SPIDDM)
• Combination of Type 1 and Type 2 DM
Gestational
DM

Other Types
 Types of Diabetes Mellitus
Primary Features of Type 1, Type 2 ad Type 1.5

Type 1 Type 2 LADA

Age at diagnosis Most commonly in childhood Most commonly in adults Usually age > 30
Presence of insulin No Yes Maybe
resistance
Time to requiring insulin At Onset Over time, if at al Greater than 6months
Less than 6 years
Presence of auto antibodies Yes No Yes
Insulin level at diagnosis Undetectable or extremely low Very high Low
 Other types of Diabetes Mellitus
• Genetic defects of ß-cell function

• Genetic defects in insulin action

• Diseases of the exocrine pancreas

• Endocrinopathies

• Drug- or chemical-induced

• Infections

• Uncommon forms of immune-mediated diabetes

• Other genetic syndromes sometimes associated with diabetes

 Pathophysiology – Type 1 DM

• Type 1 diabetes is an autoimmune disease in which the body’s own immune system attacks the
insulin-producing cells of the pancreas

• As a result, the pancreas produces little to no insulin and blood glucose levels will increase

• This is also called as Juvenile Diabetes and formerly called as IDDM

• The cause is unknown

 Pathophysiology – Type 2 DM

• Type 2 diabetes is a metabolic disorder in which the body’s response to insulin is reduced, called
insulin resistance.

• Insulin production is initially increased by the pancreatic beta cells to try to counteract the
insulin resistance.

• However, over time there is a progressive decrease in insulin production and secretion leading
to insufficient insulin levels.
Signs and Symptoms
 Signs and Symptoms

The classic signs and symptoms of untreated Diabetes are

• Polyuria (Increased urination)

• Polydipsia (Increased thirst) and
• Polyphagia (Increased hunger)
• Slow Healing

Symptoms may develop rapidly in Type 1 DM, while they develop much more slow or absent in Type 2 DM
 Diabetic Risk Factors

Family History

Non –
Modifiable
RF

Race/Ethnic
Age
background
 Diabetic Risk Factors

Weight
Other
health
issues Alcohol
(HTN, Chol
etc;)

Modifiable Risk
Factors
Sleep Diet

Physical
Stress
Activity
 Management / Treatment and Prevention

- Blood Sugar Monitoring.

- Oral diabetic Medications.

- Insulin.

- Diet and Exercise.

 ICD GL’s – Types of Diabetes Mellitus
Report E10.9
Type I (E10.9) Any Complications?
Refer to complications
Report E11.9 under E11.- YES Refer to complications under E10.-

NO YES Any Complications?

NO Report E11.9
Type II (E11.9)
YES Refer to complications under E11.-

Are complications 1. Report condition causing diabetes

documented
Due to underlying
NO 2. Report E08.9
Any Complications?
disease (E08.9)
YES 1. Report condition causing diabetes
2. Report complication using codes from E08..-
NO
1. Report poisoning due to specific drug
2. Report E09.9
Due to drugs or
NO 3. Report any additional adverse effects.
START Is the type of diabetes Any Complications?
chemicals (E09.9)
documented?
YES 1. Report poisoning due to specific drug
2. Report complication using codes from E09..-
3. Report any additional adverse effects.
YES
Due to other Any Complications? NO Report E13.9

causes (E13.9)

Type of diabetes?
YES Refer to complications under E13.-

* Use additional codes to identify long term use of insulin(Z79.4) and long term oral hypoglycemics (Z79.84)
 ICD 10 Guidelines for coding Insulin

Diabetes mellitus and the use of insulin, oral hypoglycemics,

and injectable non-insulin drugs –

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.

Additional code(s) should be assigned from category Z79 to identify the long-term (current) use
of insulin, oral hypoglycemic drugs, or injectable non-insulin antidiabetic,
as follows:

If the patient is treated with both oral hypoglycemic drugs and insulin, both code Z79.4, Long
term (current) use of insulin, and code Z79.84,Long term (current) use of oral hypoglycemic
drugs, should be assigned.
 ICD 10 Guidelines for coding Insulin

If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4,
Long term (current) use of insulin, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic
drugs.

If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug,
assign codes Z79.84, Long term (current) use of oral hypoglycemic drugs, and Z79.85, Long-term (current) use
of injectable non-insulin antidiabetic drugs.

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.
 ICD 10 Guidelines for Insulin pump malfunction
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).
 Diabetic complications

Acute Complications

• HHNS (Hyperglycemic Hyperosmolar syndrome)

• Ketoacidosis
• Hypoglycemia

Chronic Complications

• Microvascular (due to damage to small blood vessels)

• Macrovascular (due to damage to larger blood vessels)
 Diabetic complications – ICD 10 CM

• Conditions NOT found under the sub term “with” of diabetes in the index will need more
definitive linkage.

Per AHA® coding clinic for

ICD… Second quarter, 2016
• The sub term “with” in the Index should be interpreted as a link between diabetes and any of
those conditions indented under the word “with.” The physician documentation does not need to
provide a link between the diagnoses of diabetes and chronic kidney disease to accurately assign code
E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease. This link can be assumed since
the chronic kidney disease is listed under the sub term “with.” These conditions should be coded as
related even in the absence of provider documentation explicitly linking them, unless the
documentation clearly states the conditions are unrelated and due to some other underlying cause
besides diabetes. For conditions not specifically linked by these relational terms in the classification,
provider documentation must link the conditions in order to code them as related.”
 Acute Complications - Diabetic Hyperosmolarity

• Hyperosmolarity or HHNS is one of the life -

threatening complications of Diabetes, usually
triggered by another illness or infection

• It involves extremely high blood sugar (glucose)

level without the presence of ketones

• HHS is a condition of:

o Extremely high blood sugar (glucose) level

o Extreme lack of water (Dehydration)
o Decreased alertness or consciousness (in many
cases)
ICD 10 CM Alphabetic Index – Diabetic Hyperosmolarity
Using Diabetes Type 2, as an example, Diabetic E11.0X Code Range
Hyperosmolarity is classified to ICD-10 code
range “E11.0X with a 5th digit required to The appropriate last digit can be confirmed from
complete the code. the Tabular List depending upon “coma”
documentation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.
 Knowledge Corner - Diabetic hyperosmolarity

Question: A patient is diagnosed with hyperglycemic hyperosmolar ketotic state without acidosis, and
new onset type 2 diabetes. What are the codes to be reported?

Answer: Assign code, E11.00 - Type 2 diabetes mellitus with hyperosmolarity without nonketotic
hyperglycemic hyperosmolar coma (NKHHC)

Reference : AHA® Coding Clinic

Year : 2022
Issue : First Quarter
Title : Type 1 Diabetic Hyperglycemic Hyperosmolar Syndrome
 Acute Complications - Diabetic Ketoacidosis

• Diabetic Ketoacidosis is a serious, sometimes

life-threatening complication

• It occurs when too many ketones buildup and

are released into the blood stream. This
condition should be treated in an ER or
through hospital admission

• Symptoms:

o Excessive Thirst
o Increased Urination
ICD 10 CM Alphabetic Index – Diabetic Ketoacidosis
Using Diabetes Type 2, as an example, Diabetic E11.1X Code Range
Ketoacidosis is classified to ICD-10 code range
“E11.1X with a 5th digit required to complete the The appropriate last digit can be confirmed from
code. the Tabular List depending upon “coma”
documentation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.
 Knowledge Corner - Diabetic Ketoacidosis

Question: A type I diabetic patient is seen in the emergency department due to diabetic ketoacidosis.
Apparently, her insulin pump malfunctioned and stopped delivering insulin during the night and the
patient didn’t notice. How should this be coded?

Answer: Assign code T85.614A, Breakdown (mechanical) of insulin pump, initial encounter as the
first-listed diagnosis. Assign code E10.10, Type 1 diabetes mellitus with ketoacidosis without coma as
a secondary diagnosis
 Acute Complications - Diabetic Hypoglycemia

• Hyperglycemia means “low blood sugars” and

when it occurs in diabetes, it is usually caused by
issues with insulin or other treatment

• It can effect brain and bodies ability to function

• Symptoms:

o Shakiness
o Confusion
o Dizziness
o Nausea & Anxiety
ICD 10 CM Alphabetic Index – Diabetic Hypoglycemia
Using Diabetes Type 2, as an example, Diabetic E11.64X Code Range
Hypoglycemia is classified to ICD-10 code range
“E11.64X with a 6th digit required to complete The appropriate last digit can be confirmed from
the code. the Tabular List depending upon “coma”
documentation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.
 Chronic Diabetic Complications

Microvascular Macrovascular
Damage to Eyes Brain – Strokes (CVA)
Damage to Kidneys Heart – Cardiovascular
diseases such as MI
Damage to Nerves Extremities - insufficiency
in blood flow to legs
 Diabetes with Kidney Complications
• Diabetes is the leading cause of kidney disease

• As many as 1in3 adults who has kidney disease have diabetic kidney disease such as diabetic
nephropathy or diabetic CKD

• Overtime high blood sugars can damage the blood vessels in the kidneys, as a result they don’t
function correctly. The longer the person has diabetes the higher chance of kidney damage

• Damaged kidneys do not filter blood as they should which leads to waste build up in the body,
causing other issues as a result
Diabetes with Kidney Complications – DM+CKD+HTN

• ICD 10 assumes a causal relationship between CKD and HTN, and it also assumes a relationship
between Diabetes and CKD (as long as the provider doesn’t specify otherwise.

Per AHA® coding clinic for

ICD… Fourth quarter, 2018

• When the provider documented Diabetes with CKD and the patient also happens to have
Hypertension, assign codes E11.22 (Diabetes with CKD) and I12.9 (Hypertension with CKD) as well as
N18.9 (Chronic kidney disease, unspecified)

• There is no assumed relationship between diabetes and hypertension

 Diabetes with CKD and Nephropathy

Coding Alert!!!

❑ When diabetes, CKD and nephropathy are documented in the same encounter, only Diabetes with
CKD would be captured.

❑ Diabetic CKD is the most specific form of renal manifestation and takes precedence over diabetic
nephropathy.

❑ DO NOT code diabetic CKD and diabetic nephropathy

together……
ICD 10 CM Alphabetic Index – Diabetic kidney Complications

Using Diabetes Type 2, as an example, Diabetic E11.2X Code Range

kidney complications are classified to ICD-10
code range “E11.2X with a 5th digit required to The appropriate last digit can be confirmed from
complete the code. the Tabular List depending upon the type of
kidney manifestation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.

E11.22 has an instruction : Use additional code

to identify the stage of CKD (N18.1-N18.6).
 Knowledge Corner - Diabetes & ESRD
Chief Complaint: ESRD
1. E11.22 - Type 2 diabetes mellitus with
diabetic chronic kidney disease
HPI: A diabetic patient presented for End stage renal
disease (ESRD) and few chronic conditions.
2. N18.6 - End stage renal disease
Past Medical history: 1. Chronic Kidney Disease stage 4.
Reference : AHA® Coding Clinic 3. Z99.2 - Dependence on renal dialysis
Year : 2019
PE: Currently on dialysis.
Issue : Third Quarter 4. E11.42 - Type 2 diabetes mellitus with
Title : Hypertension with diabetic diabetic polyneuropathy
Assessment: 1. ESRD due to diabetic nephropathy onnephropathy and CKD
dialysis.
5. I10 - Essential (primary) hypertension
2. Neuralgia

3. Hypertension
 Diabetes with Ophthalmic Complications
• Diabetic patients often develop eye complications

• Diabetic retinopathy is one of the most common complications

and is divided into 3 types

1. Non proliferative
- Mild, moderate or severe

2. Proliferative
- with or without complications

3. Unspecified
- with or without macular edema

• Other diabetic eye complications include – diabetic cataract and

diabetic macular edema
ICD 10 CM Alphabetic Index – Diabetic Ophthalmic Complications

Using Diabetes Type 2, as an example, Diabetic E11.3X Code Range

kidney complications are classified to ICD-10
code range “E11.3X with a 5th digit, 6th and 7th The appropriate last digit can be confirmed from
digit as well in some cases required to complete the Tabular List depending upon the type of
the code. ophthalmic manifestation.

The first and second digits will vary depending

on the type of diabetes specified – E08, E09,
E10, E11 or E13.

There is no assumed link between diabetes and

macular edema as per ICD.
Knowledge Corner- Diabetic & Optic Neuropathy
Chief Complaint: Right eye pain

HPI: A 52 years old female comes for a follow up with

periorbital eye pain, floaters and blurry vision.

Medication List: 1. Metformin 5mg tablet

PE: Alert
Reference & Oriented
: AHA® Coding Clinic
Year : 2023
Assessment:
Issue 1. Diabetes
: Third Quarter
2. Optic and
Title : Diabetes Mellitus Neuropathy
Optic neuropathy

1. E11.9 - Type 2 diabetes mellitus without complication

2. H46.9 - Unspecified optic neuritis

3. Z79.84 - Long term (current) use of oral hypoglycemic drugs

Knowledge Corner- Diabetes Mellitus with Cortical Cataract

Question: A patient with cortical, nuclear, and posterior subcapsular cataracts of both eyes is seen for
right phacoemulsification clear corneal intraocular lens implant. The patient also has type 2 diabetes.

Answer: 1. E11.36 - Type 2 diabetes mellitus with diabetic cataract

2. H25.813 - Combined forms of age-related cataract, bilateral

Reference : AHA® Coding Clinic

Year : 2019
Issue : Second Quarter
Title : Diabetes Mellitus
 Diabetes with Neurological Complications
• Having diabetes can put a person at high risk for neurological complications such as peripheral
neuropathy, autonomic neuropathy, amyotrophy and mono-neuropathy

• In peripheral neuropathy, there can be numbness, sensitivity to touch and pain. The legs and
feet are often affected sometimes followed by hands and arms

• Autonomic neuropathy, affects nerves in heart, bladder, bowels, sex organs and eyes. Symptoms
can include gastroparesis, bladder/bowel problems and eye changes

• Amyotrophy, most often occurs only one side of the body but can spread to both sides and
affects nerves in thighs, hips, legs, chest, abdomen, buttocks causing pain weakness

• Mononeuropathy, refers to the damage to cranial or peripheral nerves, it can lead to double
vision, bells palsy or hand weakness
ICD 10 CM Alphabetic Index – Diabetic Neurological Complications

Using Diabetes Type 2, as an example, Diabetic E11.4X Code Range

kidney complications are classified to ICD-10
code range “E11.4X with a 5th digit required to The appropriate last digit can be confirmed from
complete the code. the Tabular List depending upon the type of
neurological manifestation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.

Code E11.43 is assigned for both diabetic

autonomic polyneuropathy as well as diabetic
gastroparesis.
Knowledge Corner- DM with Autonomic Polyneuropathy

Admit date: xx/xx/xxx

Discharge date: xx/xx/xxxx 1. E11.43 - Type 2 diabetes mellitus with

diabetic autonomic (poly)neuropathy
Discharge Diagnosis:
Reference : AHA® Coding Clinic
1. Diabetes with Dysautonomia Orthostatic Hypotension 2. I95.1 - Orthostatic hypotension
Year : 2023
Syndrome
Issue : Second Quarter
3. G90.8
Title : Diabetes with dysautonomia orthostatic - Other disorders of autonomic
hypotension
Hospital course: Patient was admitted for seizure nervous system
syndrome.
evaluation and was noted to have variable blood pressures
with significant orthostatic episodes. A neurologist was
consulted and documented “Diabetic autonomic
neuropathy type 2 with dysautonomia and hypotension.”
On discharge, the final diagnostic statement included
“dysautonomia orthostatic hypotension syndrome.”
Knowledge Corner- Diabetes Mellitus and Myasthenia Gravis

Question: The patient has been diagnosed with myasthenia gravis and also with dialysis dependent
end stage renal disease secondary to type 2 diabetes mellitus (DM).

Answer: 1. E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease

2. N18.6 - End Stage Renal Disease

3. Z99.2 - Dependence on renal dialysis

4. G70.00 - Myasthenia gravis without (acute) exacerbation

Reference : AHA® Coding Clinic

Year : 2022
Issue : Third Quarter
Title : Diabetes Mellitus and Myasthenia Gravis
 Diabetes with Circulatory Complications
• Circulatory system functions as a delivery system of the body, it carries oxygen and nutrients to
the cells in the body, carries carbon dioxide and waste away from the cells, transports hormones
helping the body communicate with organs, also transports white blood cells through the body
to combat infection

• It is also responsible for regulating body’s temperature and allows for regulation of blood glucose

• In diabetes, blood glucose can reach to high levels for extended amount of time damaging the
blood vessels

• If high numbers of blood vessels are damaged, it can cause problems in all areas of the body.
Diabetic complications from other body systems can be tracked back to circulatory system issues
of some kind like peripheral vascular disease
 Diabetes with Circulatory Complications
Why is Diabetes with PVD not found in the ICD 10 CM index???????

• Peripheral vascular disease is not found under diabetes in the ICD 10CM index though its an
assumed circulatory manifestation of diabetes

PVD = Peripheral Angiopathy

Per AHA® coding clinic for

ICD… Second quarter, 2018
• Peripheral arteriosclerosis, peripheral vascular disease and peripheral arterial disease in a diabetic
patient should be linked and coded as “diabetic peripheral angiopathy”
ICD 10 CM Alphabetic Index – Diabetic Circulatory Complications

Using Diabetes Type 2, as an example, Diabetic E11.5X Code Range

kidney complications are classified to ICD-10
code range “E11.5X with a 5th digit required to The appropriate last digit can be confirmed from
complete the code. the Tabular List depending upon the type of
circulatory manifestation.
The first and second digits will vary depending
on the type of diabetes specified – E08, E09,
E10, E11 or E13.

Code E11.52 is assigned for both diabetic

peripheral angiopathy with gangrene as well as
Type 2 DM with diabetic gangrene.
Knowledge Corner- DM with Atherosclerotic Peripheral Disease

Chief Complaint: Leg numbness

HPI: Patient presents for a follow up with leg numbness

and cramping in leg.
Reference : AHA® Coding Clinic
Medication List: 1. Plavix 10mg
Year : 2018
Issue : Third Quarter
PE: Claudication and Weak pulse in the leg
Title : Diabetes with atherosclerotic peripheral arterial disease
Assessment: 1. Diabetes
1. E11.51 – Type2. Atherosclerosis
2 Diabetic ofangiopathy
peripheral extremitywithout gangrene

2. I70.209 – Atherosclerosis of lower extremity, Unspecified

Knowledge Corner- Diabetes & Fournier Gangrene

Chief Complaint: Gangrene .

HPI: A 36- year old male patient is present for the follow up
for his Fournier gangrene.

PMH: 1. Type 2 DM .
Reference : AHA® Coding Clinic
Year : 2020
Exam: Extremity: Left leg blisters, Foul smelling &
Issue : Second Quarter
Discharge.
Title : Diabetes Mellitus with Fournier’s Gangrene
Assessment: 1. Type 2 Diabetes Mellitus
2. Fournier gangrene

1. E11.9 - Type 2 diabetes mellitus without complication

2. N49.3 - Fournier gangrene

 Knowledge Corner- Diabetes & Fournier Gangrene

Fournier’s gangrene is not a type of diabetic gangrene or Peripheral Angiopathy. Fournier’s is a bacterial
necrotizing soft tissue infection, which can occur due to trauma, postoperative complications, or other
causes
 Knowledge Corner- Diabetes with Gas Gangrene

Question: A 71-year-old male with type 2 diabetes mellitus presented to the Emergency Department
with a swollen gangrenous right foot that was diagnosed as gas gangrene.

Answer: 1. E11.52 - Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene

2. A48.0 - Gas gangrene

Reference : AHA® Coding Clinic

Year : 2017
Issue : Fourth Quarter
Title : Diabetes Mellitus and Gas Gangrene
 Diabetes with Other Specified Complications
E11.6X Diabetic Arthropathy
DM with Skin complications
DM with ulcer
DM with oral complications
DM with Osteomyelitis
DM with Hypoglycemia
DM with Hyperglycemia
Diabetes with Other Specified Complications – DM Arthropathy
• Diabetes increases the risk of arthropathic complication, affecting joint function causing pain and
inability to perform everyday activities

• Reduction of sensation in the joints from diabetic neuropathy can cause chronic arthropathy

• Charcot foot is one of the arthropathic conditions which has direct assumed relationship with
diabetes

• Symptoms: Redness, Edema causing eventual collapse of foot arch which leads to increased
pressure on the bottom of the foot
Diabetes with Other Specified Complications – DM Ulcer

Diabetic ulcers are open sores or wounds most commonly found in the bottom of the feet

Lack of sensation in foot due to poor circulation or neurological diseases can prevent sometimes from
feeling the ulcer making it difficult to diagnose in timely manner.

E11.621, E11.621 has an instruction : Use additional code to identify the

sight of ulcer (L97.1-L98.49).
Knowledge Corner - Diabetes Mellitus and Cellulitis

Question: A 79-year-old male with type 2 diabetes mellitus presented with acute cellulitis of the left
lower leg. The patient was admitted and started on broad spectrum antibiotics. What are the codes to
be reported?

Answer: 1. E11.9 - Type 2 diabetes mellitus without complication

2. L03.116 - Cellulitis of left lower limb

Reference : AHA® Coding Clinic

Year : 2017
Issue : Fourth Quarter
Title : Diabetes and Cellulitis
Diabetes with Other Specified Complications – Skin

• Almost 80% of people with diabetes have a skin disorder associated

with it such as dermatitis and necrobiosis lipoidica

• Dermatitis is a general term, which describes skin irritation or rash and

is fairly common in diabetic patients

• Necrobiosis lipoidica, occurs only in about 1% of diabetic patients. It

starts as red plaques which turn in to yellow – brown patches on shins.
It is a chronic condition which can be managed but very rarely resolved
Diabetes with Other Specified Complications – Oral

• Diabetes puts people at risk of developing periodontal disease along with other oral manifestations

• In turn, getting control of and treating periodontal disease can have a positive effect on control of
diabetes
Diabetes with Other Specified Complications – Osteomyelitis

• Osteomyelitis is a serious complication that is due to non healing ulcers and is associated with a
high risk of amputation

• It can affect any bone but most often seen in the foot

• Symptoms : Swelling, redness or even blood with bone fragments

• Diagnosis can be done through X-ray to detect the affected bones

• Treatment depends on the severity, surgical removal can mean removal of bone or it can be as
severe as amputation of limb
Diabetes with Other Specified Complications – Hyperglycemia

• Hyperglycemia refers to high glucose levels in the blood

• In diabetes it can be triggered by inadequate insulin, eating more than usual or stress

• Symptoms : Increased urination, increased thirst

 Diabetes with Other Specified Complications – Hyperglycemia

Is uncontrolled diabetes Hyperglycemia???????

Per AHA® coding clinic for

ICD… First quarter, 2017
There is no default code for “uncontrolled diabetes.” uncontrolled diabetes is classified by type and whether it is
hyperglycemia or hypoglycemia. If the documentation is not clear, query the provider for clarification whether
the patient has hyperglycemia or hypoglycemia so that the appropriate code may be
reported; uncontrolled diabetes indicates that the patient’s blood sugar is not at an acceptable level, because it is
either too high or too low.
In the ICD-10-CM Index to Diseases, uncontrolled diabetes can be referenced as follow
 Knowledge Corner - Uncontrolled DM

Question: A patient is diagnosed with uncontrolled type I diabetes mellitus (DM), hyperglycemia, and
acute hyperglycemic hyperosmolar syndrome (HHS).

Answer: 1. E10.69, Type 1 diabetes mellitus with other specified complication

2. E87.0, Hyperosmolality and hypernatremia

3. E10.65, Type I diabetes mellitus with hyperglycemia

Reference : AHA® Coding Clinic

Year : 2022
Issue : First Quarter
Title : Type 1 Diabetic Hyperglycemic Hyperosmolar Syndrome
 Knowledge Corner - Type 1.5 DM

Question: A 14-year-old female patient was seen in the Diabetes Clinic for a follow up visit. The
provider documented Combination type 1 and type 2, diabetes mellitus in poor control. What are the
codes to be reported?

Answer: 1. E13.65 - Other specified diabetes mellitus with hyperglycemia

Reference : AHA® Coding Clinic

Year : 2018
Issue : Third Quarter
Title : Type 1.5 Diabetes Mellitus
 Knowledge Corner - Type 1.5 DM

Type 1.5 diabetes is a form of diabetes in which an adult has features of both type 1 and type 2 diabetes.
These patients have also been described with the terms “latent autoimmune diabetes of adults” (LADA),
and “slow progressing type 1 diabetes.”
 Diabetes with Unspecified Complications
• Documentation of diabetes with unspecified complication doesn’t require an additional code to
identify the complication

• Codes titled “unspecified” are for the use when information in the medical record is insufficient to
assign a more specific code
Diabetes has been around a long time, but we still need new and better therapies.

THANK YOU!!!