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ICD-10 Coding for Type 2 Diabetes Mellitus Uncontrolled(E11.65, E11.64)

Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes Mellitus Uncontrolled. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Uncontrolled Type 2 DiabetesType 2 Diabetes with HyperglycemiaType 2 Diabetes with Hypoglycemia

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Related ICD-10 Code Ranges

Complete code families applicable to Type 2 Diabetes Mellitus Uncontrolled

E11.0-E11.9Primary Range

Type 2 Diabetes Mellitus

This range includes all codes related to Type 2 Diabetes Mellitus, including controlled and uncontrolled states.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
E11.65Type 2 diabetes mellitus with hyperglycemiaUse when hyperglycemia is documented in a patient with Type 2 Diabetes Mellitus.
  • HbA1c >7% within 90 days
  • Fasting glucose >130 mg/dL
  • Symptoms such as polyuria or polydipsia
E11.64Type 2 diabetes mellitus with hypoglycemiaUse when hypoglycemia is documented in a patient with Type 2 Diabetes Mellitus.
  • Glucose <70 mg/dL with symptoms
  • Documentation of hypoglycemia etiology

Clinical Decision Support

Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.

Key Information: ICD-10 code for uncontrolled type 2 diabetes

Essential facts and insights about Type 2 Diabetes Mellitus Uncontrolled

The ICD-10 code for uncontrolled type 2 diabetes with hyperglycemia is E11.65. For hypoglycemia, use E11.64.

Primary ICD-10-CM Codes for diabetes type 2 uncontrolled

E11.65
Type 2 diabetes mellitus with hyperglycemia
Billable Code

Decision Criteria

clinical Criteria

  • Presence of hyperglycemia symptoms and lab results

documentation Criteria

  • Explicit mention of hyperglycemia in medical records

Applicable To

  • Uncontrolled type 2 diabetes with hyperglycemia

Excludes

  • Type 1 diabetes mellitus (E10.-)

Clinical Validation Requirements

  • HbA1c >7% within 90 days
  • Fasting glucose >130 mg/dL
  • Symptoms such as polyuria or polydipsia

Code-Specific Risks

  • Incorrectly coding without documented hyperglycemia
  • Omitting related complications

Coding Notes

  • Ensure hyperglycemia is explicitly documented to use E11.65.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of insulin

Z79.4
Use when the patient is on long-term insulin therapy.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Type 2 diabetes mellitus without complications

E11.9
Use E11.9 when diabetes is controlled or when no specific complications are documented.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Type 2 Diabetes Mellitus Uncontrolled to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.

Impact

Clinical: Misrepresentation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.

Mitigation Strategy

Review documentation for control status, Educate providers on coding requirements

Impact

Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data affecting patient care.

Mitigation Strategy

Ensure hyperglycemia is documented with lab results or symptoms.

Impact

Lack of specific documentation can lead to audit issues.

Mitigation Strategy

Implement EHR templates requiring hyperglycemia documentation.

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 Type 2 Diabetes Mellitus Uncontrolled, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Type 2 Diabetes Mellitus Uncontrolled

Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes Mellitus Uncontrolled. These templates include all required elements for proper coding and billing.

Endocrinology Progress Note

Specialty: Endocrinology

Required Elements

  • Type of diabetes
  • Control status
  • Complications
  • MEAT elements

Example Documentation

Assessment: T2DM uncontrolled (E11.65) with hyperglycemia. Plan: Adjust insulin regimen.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Diabetes uncontrolled.
Good Documentation Example
T2DM with hyperglycemia (HbA1c 8.4%), uncontrolled despite adherence to metformin 1000mg BID.
Explanation
The good example specifies the type of diabetes, control status, and treatment details.

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