Download Diabetes Mellitus

CIRCULATORY
DM w/circulatory DM w/diabetic
periph.angiopathy without
complications
gangrene
DM w/diabetic
periph.angiopathy with
gangrene
DM w/other circulatory
complication
DM I (E10)
DM II (E11)
E10.51
E11.51
E10.52
E11.52
E10.59
E11.59
DM I (E10) DM II (E11)
NEUROLOGICAL
DM w/neurological DM w/diabetic
complications
neuropathy, unsp
E10.40
E11.40
E10.41
E11.41
E10.42
E11.42
DM w/diabetic
autonomic
(poly)neuropathy
w/diabetic gastroparesis
E10.43
E11.43
DM w/diabetic
amyotrophy
E10.44
E11.44
DM w/other diabetic
neurological complication
E10.49
E11.49
DM w/diabetic
mononeuropathy
DM w/diabetic
polyneuropathy
w/diabetic neuralgia
DM w/OTHER SPECIFIED
COMPLICATIONS
DM I (E10) DM II (E11)
DM with diabetic arthropathy
w/diab. Neuropathic arthropathy
with other diab. Arthropathy
E10.61-
E11.61-
E10.610
E10.618
E11.610
E11.618
E10.62E11.62DM with skin complications
DM with diabetic Dermatitis E10.620
E11.620
DM with foot ulcer E10.621
E11.621
And site L97.4-,L97.5DM with other skin ulcer E10.622
E11.622
And site L97.1L97.9,L98.41-L98.49
E10.628
E11.628
DM with other skin complication
DM with oral complications
DM with periodontal disease
DM with other oral complications
DM with hypoglycemia
with coma
without coma
DM with hyperglycemia
DM with other specified complication
DM with unspecified complications
DM without complications
Insulin Use
E10.63E10.630
E10.638
E11.63E11.630
E11.638
E10.64E10.641
E10.649
E11.64E11.641
E11.649
E10.65
E11.65
E10.69
E11.69
And code for complication
(Ex: Male erectile
dysfunction, unsp.(N52.9)
E10.8
E11.8
E10.9
E11.9
Z79.4
OTHER
Code
Diabetes Mellitus due to an
underlying condition
Code first the underlying
condition
E08
Drug or chemical induced DM
Code first poisoning due to drug
or toxin, if applicable (T36-T65
with 5th or 6th character 1-4 or
6)
E09
Other specified diabetes mellitus
E13
ICD-10-CM Coding Examples for DM
1 - Patient with severe non-proliferative diabetic retinopathy
with macular edema due to insulin-dependent DM II
- DMII with severe non-proliferative diabetic retinopathy with
macular edema (E11.341) and Long-term use of insulin
(Z79.4). Rationale: Combination code. No other code is
necessary.
2 - Type 1 diabetes mellitus with moderate non-proliferative
diabetic retinopathy with macular edema
- Code E10.331 that includes: Type of diabetes, Body system
involved and complications of the body system. No additional codes are necessary.
3 - DM II with complications with moderate diabetes-related
CKD.
- Type 2 diabetes mellitus with diabetic CKD (E11.22) and
CKD, stage 3 (moderate) (N18.3).
Rationale: A note under the code for DM II with diabetic
CKD instructs to use an additional code to identify the stage
of CKD (N18.1–N18.6).
4 - A type 2 diabetic patient is evaluated for a chronic diabetic
left foot ulcer with necrosis of muscle. The patient takes
insulin on a daily basis.
- Type 2 DM with foot ulcer (E11.621), Non-pressure ulcer of
other part of left foot w/necrosis of muscle (L97.523) and
long-term (current) use of insulin (Z79.4).
Rationale: Note under code E11.621 states to use additional
code to identify site of ulcer (L97.4-L97.5-)
5 - Secondary diabetes due to pancreatitis; diabetic hyperglycemia on insulin
- Idiopathic acute pancreatitis (K85.0). Code first underlying
condition
- DM due to underlying condition with hyperglycemia
(E08.65). Secondary DM code
- Long-term (current) use of insulin (Z79.4)
6 - Patient with Type 2 diabetes is diagnosed with bilateral macular edema and bilateral microaneurysms of the retina. The
patient’s diabetes is out of control.
- DM2, macular edema (E11.311)
- Bilateral Microaneurysm (H35.043)
- Hyperglycemia (E11.65)
Diabetes
Mellitus
E08-E13
ICD-10-CM
References
 library.ahima.org/xpedio/groups/public/documents/ahima/
bok1_049595.hcsp?dDocName=bok1_049595
 www.codeitrightonline.com/ciri/coding-diabetes-mellitus-in-icd-10cm.html
 www.hcpro.com/HIM-282660-8160/ICD9CM-vs-ICD10CM-Examine
-the-differences-in-diabetes-coding.html
 static.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/db0bf111b6ae-4902-9b35-4b9da2a0a480/7530ff45-c4c8-4bdd-9caa21084c3855da.pdf
 www.justcoding.com/icd-10
 www.hipaaspace.com/Medical_Billing/Coding/
International_Classification_Of_Diseases/ICD10_Codes_Lookup.aspx
 Centers for Medicare and Medicaid Services. "2012 ICD-10-CM and
GEMs." www.cms.gov
July 2016
Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services
provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and
Blue Shield Association, an association of independent Blue Cross and Blue
Shield plans.
Diabetes Mellitus and ICD-10-CMS
One of the major changes in the guidelines from ICD-9-CM to
ICD-10-CM is coding for Diabetes mellitus. This is due to the
creation of combination codes that are greatly used in coding for
diabetes conditions.
In ICD-10-CM, those codes include the type of diabetes, body
system affected and the specified complications involving the
body system.
The creation of these expanded combination codes permit for
multiple conditions to be reported with fewer codes. The type of
DM is mentioned first in order to assign the most appropriate
codes.
The digits will represent the status of the condition as:
 3rd- Type of Diabetes
 4th- Underlying conditions with specified complications
 5th-Specific manifestation, such as neuropathy, angiopathy.
The terms controlled and uncontrolled are no
longer used for diabetes in ICD-10. Instead,
DM that is uncontrolled will be coded as DM
with hyperglycemia
There are 5 categories for Diabetes broken down
according to the type.
Codes from categories E08-E09 have a “code first” note indicating that diabetes is to be sequenced after the underlying condition, drug or chemical that is responsible for the diabetes, if
applicable.
 Codes begin with an E (for Endocrine). Alpha characters are not







 E08 – Diabetes mellitus due to underlying condition (Code first
the underlying condition such as Cushing’s syndrome (E24.-).
Example: DM due to underlying condition with diabetic
nephropathy. Code: E08.21.
 E09 – Drug or chemical induced diabetes mellitus. Code first
(T36-T65 from the table of drugs and chemicals) to identify drug
or chemical, if applicable. Use additional code to identify any
insulin use (Z79.4). Ex: A physician documents an initial encounter with a patient who has corticosteroid-induced diabetes
mellitus without complications. Codes: T38.0X5A, adverse effect of glucocorticoids and synthetic analogues, initial encounter
and E09.9, drug or chemical induced diabetes mellitus without
complications

Codes from categories E10-E13 DM are sequenced first,
followed by codes for any additional complications outside of
these categories, if applicable.
 E10 – Type I diabetes mellitus (DM is sequenced first)
 Example: A patient with type 1 diabetes has developed moderate
nonproliferative diabetic retinopathy. Code: E10.339 (type 1
DM with moderate nonproliferative diabetic retinopathy without
macular edema)
 E11 – Type 2 diabetes mellitus (DM is sequenced first)
 Example: Patient with Diabetes and ESRD on dialysis. Codes:
E11.22, (DMII with CKD) N18.6 (stage) Z99.2 (dialysis)
 E13– Other specified diabetes mellitus (Includes DM due to
genetic defects, postpancreatectomy, postprocedural and secondary diabetes mellitus NEC.
Coding References by System
Some Characteristics



case-sensitive.
If the type is unclear or not documented, Diabetes mellitus, type II
(E11.-) would be used as default.
ICD-10-CM provides coders with a much greater range of codes to
choose from in the E08–E13 (Diabetes mellitus) series. As a result,
providers must document additional information to describe complications of Diabetes.
Diabetes codes in ICD-10-CM can have up to 6 characters. The first
3 characters represent the category. The 4th character identifies the
presence of manifestations or complications. The 5th and 6th characters identify specific types of manifestation.
Categories E08-E09 and E11-E13 related to DM, include a note
regarding the usage of an additional code to identify any insulin use.
Code Z79.4 Long-term current use of insulin will identify the use of
insulin for diabetic management, routinely used. It is not correct to
assign Z79.4 in the category E10 codes. On patients with type 1
diabetes, the use of insulin is required therefore Z79.4 is redundant.
New Diabetic complications include: Diabetes with skin complications; with oral complications and with arthropathy. Ophthalmic
conditions are expanded as well.
As with all complications, the documentation must link the condition to the diabetes. Example: CKD, stage IV due to diabetic
nephropathy (E11.21/N18.4).
Documenting diabetic with complications entails connecting the
Diabetes to the specific complaint by noting the complication is
diabetic or stating that it is secondary to diabetes. Documenting the
associated signs, symptoms and any results of studies is important
to support the diagnosis.
ICD-10-CM does not presume a connection between osteomyelitis
and Diabetes. The relationship between both conditions needs to be
documented by the Physician in order to be coded as such.
The default for DKA (Diabetic Ketoacidosis) is Diabetes type 1.
There is no Index entry to report this diagnosis in patients with type
2 diabetes.
There is no current mechanism in ICD-10-CM to report hyperosmolarity in a patient with DM I.
Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 diabetic patient’s blood sugar under control during an encounter.
Comparison
A 50 years old female with DM I and HTN was recently diagnosed with
diabetic nephropathy. Patient comes to the office for insulin adjustment.
ICD –9-CM
 250.41: DM I with renal manifestations, not
stated as uncontrolled
 583.81: Nephritis & nephropathy, not specified as acute or chronic, in diseases classified elsewhere
 401.9 : HTN, unspecified
ICD-10-CM
 E10.21: DMI with
diabetic nephropathy
 I10 : Essential
(primary) HTN
DM I (E10)
RENAL
DM
w/ketoacidosis
DM w /
hyperosmolarity
DM w/kidney
complications
w/o coma
E10.10
with coma
E10.11
DM II (E11)
w/o nonketotic
hyperglycemichyperosmolar coma
E11.00
with coma
E11.01
DM w/ diabetic
nephropathy
E10.21
DM w/CKD
E11.21
E10.22 and E11.22
STAGES
DM w/ other diabetic
kidney complication.
Ex: Proteinuria
(R80.9)
N18.1
N18.2
N18.3
N18.4
N18.5
CKDI
CKDII
CKDIII
CKDIV
CKDV
END+
N18.6
Dialysis(Z99.2)
CKD, unsp.
N18.9
E10.29
E11.29
OPHTHALMIC
DM I (E10)
DM with
DM w/unsp. Diabetic
ophthalmic retinopathy
E10.31complications
with Macular edema E10.311
DM II (E11)
without Macular edema
DM w/mild non proliferative
Diabetic retinopathy
E10.319
E11.319
E10.32-
E11.32-
with Macular edema
E10.321
E11.321
without Macular edema
DM w/moderate non
proliferative Diabetic
retinopathy
E10.329
E11.329
E10.33-
E11.33-
with Macular edema
E10.331
E11.331
without Macular edema
E10.339
E11.339
DM w/severe non proliferative
Diabetic retinopathy
E11.31E11.311
E10.34-
E11.34-
with Macular edema
E10.341
E11.341
without Macular edema
E10.349
E11.349
DM w/ proliferative Diabetic
retinopathy
E10.35-
E11.35-
with Macular edema
E10.351
E11.351
without Macular edema
E10.359
E11.359
E10.36
E11.36
E10.39
E11.39
DM w/ Diabetic cataract
DM w/ other diabetic
ophthalmic complication
And manifestations: H40-H42