Download ICD-10-CM: Diabetes Mellitus

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ICD-10-CM: Diabetes Mellitus
May 27, 2015
What is diabetes?
A disease in which the body does not control the amount of glucose (a type
of sugar) in the blood and the kidneys make a large amount of urine. This
disease occurs when the body does not make enough insulin or does not use
it the way it should. NIH - National Cancer Institute
Diabetes is mainly found in Chapter 4: Endocrine, Nutritional, and
Metabolic Diseases, of ICD-10-CM
•
Exception is when complicating pregnancy, childbirth and the
puerperium (O24)
•
Additional code(s) from E08-E13 are assigned to identify
any manifestations
In ICD-10-CM there are five updated Diabetes Mellitus categories to
reflect the current clinical classification and manifestations:
• 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
• Note: No longer use controlled and uncontrolled. The new
system now classifies inadequately controlled, out of control,
and poorly controlled diabetes mellitus by type with
hyperglycemia.
Vol. 13
Coding practice: Code Diagnostic codes only
Scenario: This insulin dependent type 2 diabetic patient has a severe chronic
diabetic foot ulcer of the left midfoot, with exposed fat layer, with diabetic
peripheral angiopathy. He also has diabetic stage 2 chronic kidney disease,
and diabetic gastroparesis. He is being evaluated for possible surgical
intervention of his foot ulcer.
• What should be coded in this example?
1.
2.
3.
4.
5.
Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer
Diabetic peripheral angiopathy
Diabetic stage 2 chronic kidney disease
Diabetic gastroparesis
Long term insulin use
1. Chronic diabetic foot ulcer of the left midfoot, with exposed fat layer
E11.621
ICD-10-CM Index
Diabetes, diabetic (mellitus) (sugar) E11.9
- type 2 E11.9
-- with
- - - foot ulcer E11.621
Type 1 Diabetes, E10 (O24.0 in Pregnancy, Childbirth, and the Puerperium)
•
The body does not produce insulin.
•
Some people may refer to this type as insulin-dependent
diabetes, juvenile diabetes, or early-onset diabetes.
•
People usually develop type 1 diabetes before their 40th
year, often in early adulthood or teenage years.
Approximately 10% of all diabetes cases are type 1.
Patients with type 1 diabetes will need to take insulin
injections for the rest of their life.
•
•
Type 2 Diabetes, E11 (O24.1 in Pregnancy, Childbirth, and the Puerperium)
•
•
•
The body does not produce enough insulin for proper function, or the
cells in the body do not react to insulin (insulin resistance).
Approximately 90% of all cases of diabetes worldwide are of this
type.
Some people may be able to control their type 2 diabetes symptoms
by losing weight, following a healthy diet, doing plenty of exercise,
and monitoring their blood glucose levels.
•
However, type 2 diabetes is typically a progressive
disease - it gradually gets worse - and the patient will
probably end up have to take insulin, usually in tablet
form.
Gestational Diabetes – Found in Chapter 15: Pregnancy, Childbirth, and the
Puerperium, O24.4_
• This type affects females during pregnancy. Some women have very
high levels of glucose in their blood, and their bodies are unable to
produce enough insulin to transport all of the glucose into their cells,
resulting in progressively rising levels of glucose.
• Diagnosis of gestational diabetes is made during pregnancy.
• The majority of gestational diabetes patients can control their
diabetes with exercise and diet.
•
Between 10% to 20% of them will need to take some kind of
blood-glucose-controlling medications.
•
Undiagnosed or uncontrolled gestational diabetes can raise the
risk of complications during childbirth. The baby may be bigger
than he/she should be.
1. B) Chronic diabetic foot ulcer of the left midfoot, with exposed
fat layer L97.422
ICD-10-CM Index
Ulcer, ulcerated, ulcerating, ulceration,
ulcerative
foot (indolent) (trophic) —see Ulcer,
lower limb
lower limb (atrophic) (chronic)
(neurogenic) (perforating) (pyogenic)
(trophic) (tropical) L97.909
-midfoot L97.409
- - - left L97.429
- - - - with
- - - - - exposed fat layer L97.422
Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that
include
• The type of DM, the body system affected, and the complication
affecting that body system as part of the code description.
•
Subcategory levels first specify the type of complication
by system, such as diabetes with kidney complications,
ophthalmic complications, neurological complications,
and circulatory complications.
•
The subclassification level then describes
the particular manifestation.
Example:
ICD-10-CM Index
Diabetes, diabetic (mellitus) (sugar)
E11.9
- type 2 E11.9
-- with
- - - peripheral angiopathy E11.51
•
•
•
•
Use as many codes as are needed to describe all of the associated
complications that the patient has from a particular category.
Because of this code structure, there is no instructional note found
under diabetes mellitus codes in ICD-10-CM requiring an additional
code to identify the manifestation since it is already part of the code
description.
There are specific diabetes codes that do require additional codes in
order to identify the manifestation further, such as diabetes with foot
ulcer to identify the site of the ulcer, or diabetes with chronic kidney
disease to identify the stage of chronic kidney disease.
For example, the code E10.22 ( Type 1 diabetes mellitus with chronic
kidney disease) requires the use of an additional code to identify the
stage of chronic kidney disease (N18.1-N18.6)
Physicians should document whether the diabetes is:
•
•
•
•
•
•
•
Type 1,
Type 2,
Drug- or chemical-induced,
Due to an underlying condition.
The specific underlying condition,
The specific drug or toxin,
The use of any insulin
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ICD-10-CM Tabular
E11 Type 2 diabetes mellitus
Use additional code to identify any insulin
use (Z79.4)
E11.5 Type 2 diabetes mellitus with
circulatory complications
E11.51 Type 2 diabetes mellitus with
diabetic peripheral angiopathy without
gangrene
3. Diabetic stage 2 chronic kidney disease E11.22
ICD-10-CM Index
Diabetes, diabetic (mellitus) (sugar) E11.9
- type 2 E11.9
-- with
- - - chronic kidney disease E11.22
ICD-10-CM Tabular
E11 Type 2 diabetes mellitus
Use additional code to identify any insulin
use (Z79.4)
E11.2 Type 2 diabetes mellitus with
kidney complications
E11.22 Type 2 diabetes mellitus with
diabetic chronic kidney disease
Use additional code to identify stage of
chronic kidney disease (N18.1-N18.6)
3. B) Diabetic stage 2 chronic kidney disease N18.2
ICD-10-CM Index
Disease, diseased —see also
Syndrome
kidney (functional) (pelvis) N28.9
-- chronic N18.9
- - - stage 2 (mild) N18.2
ICD-10-CM Tabular
N18 Chronic kidney disease (CKD)
Code first any associated:
diabetic chronic kidney disease (E08.22,
E09.22, E10.22, E11.22, E13.22)
hypertensive chronic kidney disease
(I12.-, I13.-)
Use additional code to identify kidney
transplant status, if applicable, (Z94.0)
N18.2 Chronic kidney disease, stage 2
(mild)
4. Diabetic gastroparesis E11.43
ICD-10-CM Index
Diabetes, diabetic (mellitus) (sugar)
E11.9
- type 2 E11.9
-- with
- - - gastroparesis E11.43
E10 Type 1 diabetes mellitus
E10.2 Type 1 diabetes mellitus with kidney complications
E10.21 Type 1 diabetes mellitus with diabetic nephropathy
Coders should know:
ICD-10-CM Tabular
L97 Non-pressure chronic ulcer of lower limb,
not elsewhere classified
L97.4 Non-pressure chronic ulcer of heel
and midfoot
L97.42 Non-pressure chronic ulcer of
left heel and midfoot
L97.422 Non-pressure chronic
ulcer of left heel and midfoot
with fat layer exposed
2. Diabetic peripheral angiopathy E11.51
ICD-10-CM Official Guidelines for Coding and Reporting FY 2015
I, C, 4, a, 6), Secondary diabetes mellitus
• Codes under categories 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 is
always caused by another condition or event (e.g., cystic fibrosis,
malignant neoplasm of pancreas, pancreatectomy, adverse effect of
drug, or poisoning).
ICD-10-CM Tabular
E11 Type 2 diabetes mellitus
Use additional code to identify any insulin
use (Z79.4)
E11.6 Type 2 diabetes mellitus with other
specified complications
E11.62 Type 2 diabetes mellitus with
skin complications
E11.621 Type 2 diabetes
mellitus with foot ulcer
Use additional code to identify
site of ulcer (L97.4-, L97.5-)
ICD-10-CM Tabular
E11 Type 2 diabetes mellitus
Use additional code to identify any insulin
use (Z79.4)
E11.4 Type 2 diabetes mellitus with
neurological complications
E11.43 Type 2 diabetes mellitus with
diabetic autonomic (poly)neuropathy
Type 2 diabetes mellitus with
diabetic gastroparesis
5. Long term insulin use Z79.4
ICD-10-CM Index
Long-term (current) (prophylactic) drug
therapy (use of)
- insulin Z79.4
ICD-10-CM Tabular
Z79 Long term (current) drug therapy
Z79.4 Long term (current) use of insulin
Final diagnostic codes:
1. Chronic diabetic foot ulcer of the left midfoot, with exposed
fat layer E11.621
1. B) Chronic diabetic foot ulcer of the left midfoot, with
exposed fat layer L97.422
2. Diabetic peripheral angiopathy E11.51
3. Diabetic stage 2 chronic kidney disease E11.22
3. B) Diabetic stage 2 chronic kidney disease N18.2
4. Diabetic gastroparesis E11.43
5. Long term insulin use Z79.4
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