ICD-10 Coding for Diabetes Mellitus with Hyperglycemia(E11.65)
Complete ICD-10-CM coding and documentation guide for Diabetes Mellitus with Hyperglycemia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Diabetes Mellitus with Hyperglycemia
E08-E13Primary Range
Diabetes mellitus
This range includes all types of diabetes mellitus, including those with complications such as hyperglycemia.
Key Information: ICD-10 code for diabetes mellitus with hyperglycemia
Essential facts and insights about Diabetes Mellitus with Hyperglycemia
Primary ICD-10-CM Code for diabetes mellitus with hyperglycemia
Decision Criteria
clinical Criteria
- Patient has type 2 diabetes with documented hyperglycemia.
Applicable To
- Type 2 diabetes with high blood sugar
Excludes
- Type 1 diabetes mellitus with hyperglycemia (E10.65)
Clinical Validation Requirements
- Fasting glucose ≥126 mg/dL
- Random glucose ≥200 mg/dL
- A1C ≥6.5%
- Symptoms such as polyuria or polydipsia
Code-Specific Risks
- Misclassification if hyperglycemia is not explicitly documented.
Coding Notes
- Ensure hyperglycemia is documented explicitly in the medical record.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Diabetes Mellitus with Hyperglycemia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure provider documents hyperglycemia explicitly., Query provider if documentation is unclear.
Impact
Reimbursement: Potential claim denials due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure hyperglycemia is documented and use E11.65.
Impact
Risk of audit if hyperglycemia is not documented explicitly.
Mitigation Strategy
Educate providers on the importance of documenting hyperglycemia.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Diabetes Mellitus with Hyperglycemia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Diabetes Mellitus with Hyperglycemia
Use these documentation templates to ensure complete and accurate documentation for Diabetes Mellitus with Hyperglycemia. These templates include all required elements for proper coding and billing.
Endocrinology Clinic Visit
Specialty: EndocrinologyRequired Elements
- Type of diabetes
- Blood glucose levels
- A1C results
- Symptoms of hyperglycemia
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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