Did you know that November is American Diabetes Month? According to the Centers for Disease Control and Prevention (CDC), approximately 30 million people in the United States have diabetes. One out of every four people with the condition don’t even know they have it, and according to the National Institute of Diabetes and Digestive and Kidney Diseases, “an estimated 84.1 million Americans aged 18 years or older have prediabetes.”
The American Diabetes Association (ADA) encourages everyone to participate in their This Is Diabetes campaign encouraging Americans to pledge support by donating to support research, education, and prevention and becoming an advocate to support efforts to find a cure, improve access to health care, and protect the rights of people with diabetes.
About Diabetes Mellitus
The CDC reports that the top three risk factors for developing diabetes, also known as diabetes mellitus (DM), are being overweight or obese, having high blood pressure, and having hyperlipidemia. In the last two decades, the number of people diagnosed with diabetes has tripled. It is also the leading cause of lower-limb amputation and adult-onset blindness, and was the seventh leading cause of death in 2015.
There are three main types of diabetes: type I, type II, and gestational. No matter the type of diabetes, there are serious effects. The symptoms of any type of diabetes may include excessive thirst or hunger, dry mouth, frequent urination, fatigue, and headaches.
Types of Diabetes
Type I diabetes is the result of an autoimmune disorder that prevents your body from making insulin, a hormone that acts like a key to let blood sugar into cells for use as energy. Because of this inability to use insulin, symptoms can develop rapidly and severely. An insulin replacement is required to bring blood glucose levels down and must be administered directly into the bloodstream through either shots or an insulin pump. The dose of insulin needs to be monitored often and the dosage of insulin regularly adjusted. Type I diabetes is less common than type II diabetes, and makes up only about 5% of all diagnoses. Currently, there is no cure and no way to prevent type I diabetes.
The majority of people diagnosed with diabetes have type II. With type II diabetes, your body doesn’t use insulin efficiently and is unable to keep blood sugar at normal levels, damaging various organs in the body including the nerves, eyes, heart, kidneys, gums, and teeth. Typically, type II diabetes can be controlled with a combination of diet, exercise, and medication in the form of oral or injected insulin. While the symptoms with type I diabetes can develop rapidly, type II diabetes typically develops over a span of years and can be difficult to recognize.
Gestational DM occurs when a pregnant woman develops diabetes, typically around the 24th week of pregnancy. The woman’s body is unable to make enough insulin to keep up with the many changes occurring in her body. This type of diabetes is usually temporary, but increases the risk of developing type II diabetes later in life for both the woman and her baby. It is estimated that 50% of women who have had gestational diabetes go on to develop type II diabetes.
People with all types of diabetes are at a higher risk for developing serious health complications such as:
- Heart disease and stroke
- Blindness and eye problems
- Kidney disease
Do You Know How to Code Diabetes?
The How to Code ICD-10-CM Refresher program includes specifics on coding the different types of diabetes mellitus and other related conditions. This program also covers some of the more difficult areas of ICD-10-CM coding, and is worth eight (8) continuing education units (CEUs) with both AHIMA and AIHC.
For more details about AIHC coding refresher programs, check out our ICD-10 course information packets:
For now, here is a basic overview of what factors must be taken into account when coding diabetes.
ICD-10 has combination coding for diabetes mellitus, which means that the codes include the type of diabetes mellitus, the body system affected, and the complications affecting the body system. You must review the medical documentation to determine which diabetes category is appropriate for each code assignment.
E08.00 ‑E08.9 E08 Diabetes mellitus due to underlying condition
E09.00 ‑E09.9 E09 Drug or chemical induced diabetes mellitus
E10.10 ‑E10.9 E10 Type I diabetes mellitus
E11.00 ‑E11.9 E11 Type II diabetes mellitus
E13.00 ‑E13.9 E13 Other specified diabetes mellitus
Avoid using vague codes to report diabetes. Work with your providers to capture meaningful documentation in the patient’s medical record.
When the type of diabetes mellitus is not documented in the medical record, the default is E11.-, Type II diabetes mellitus. Metabolic disorders other than diabetes are classified to categories E70-E89. Evidence in the medical record associated with the encounter to support other related conditions is important. When assigning diabetes codes, reference the Tabular for directives guiding you to code another condition first, to use an additional code and certainly watch out for any Excludes1 notes!
For example, E08.00: Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
Take into consideration these guidelines for category E08 codes:
- Category E08 guidelines:
- Code First: the underlying condition, such as:
- congenital rubella (P35.0)
- Cushing's syndrome (E24.-)
- cystic fibrosis (E84.-)
- malignant neoplasm (C00-C96)
- malnutrition (E40-E46)
- pancreatitis and other diseases of the pancreas (K85-K86.-)
- Use additional code to identify control using:
- insulin (Z79.4)
- oral antidiabetic drugs (Z79.84)
- oral hypoglycemic drugs (Z79.84)
- Excludes1: drug or chemical induced diabetes mellitus (E09.-)
- gestational diabetes (O24.4-)
- neonatal diabetes mellitus (P70.2)
- postpancreatectomy diabetes mellitus (E13.-)
- postprocedural diabetes mellitus (E13.-)
- secondary diabetes mellitus NEC (E13.-)
- type I diabetes mellitus (E10.-)
- type II diabetes mellitus (E11.-)
The information contained in this article is provided by the staff and consultants of the American Institute of Healthcare Compliance, Inc. (AIHC), a non-profit 501(c)(3) training organization.