ICD-10 Coding for Type 2 Diabetes Mellitus with Complications(E11.22, E11.42, E11.65)
Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes Mellitus with Complications. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Type 2 Diabetes Mellitus with Complications
E11.0-E11.9Primary Range
Type 2 diabetes mellitus
This range includes all codes related to type 2 diabetes mellitus, including those with specific complications.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease | Use when chronic kidney disease is documented as a complication of type 2 diabetes. |
|
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy | Use when neuropathy is documented as a complication of type 2 diabetes. |
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| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Use when hyperglycemia is documented as a complication of type 2 diabetes. |
|
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 type 2 diabetes with complications
Essential facts and insights about Type 2 Diabetes Mellitus with Complications
Primary ICD-10-CM Codes for diabetes type 2 with complications
Decision Criteria
documentation Criteria
- Documentation must explicitly state 'diabetic nephropathy' or similar.
Applicable To
- Diabetic nephropathy
- Diabetic renal disease
Excludes
- Chronic kidney disease due to hypertension (I12.-)
Clinical Validation Requirements
- eGFR <60 mL/min/1.73m2
- Albuminuria (ACR ≥30 mg/g)
Code-Specific Risks
- Incorrectly coding without documented causal relationship
Coding Notes
- Ensure documentation specifies the causal relationship between diabetes and CKD.
E11.42 - Type 2 diabetes mellitus with diabetic polyneuropathy
Use when neuropathy is documented as a complication of type 2 diabetes.
Applicable To
- Diabetic neuropathy
Excludes
- Alcoholic neuropathy (G62.1)
Clinical Validation Requirements
- Loss of vibratory sensation below knees
- Monofilament test ≤5/8 sites
Coding Notes
Ensure documentation specifies the causal relationship between diabetes and neuropathy.
E11.65 - Type 2 diabetes mellitus with hyperglycemia
Use when hyperglycemia is documented as a complication of type 2 diabetes.
Applicable To
- Diabetes with hyperglycemia
Excludes
- Diabetes with hypoglycemia (E11.649)
Clinical Validation Requirements
- Fasting glucose ≥126 mg/dL
- Random glucose ≥200 mg/dL
Coding Notes
Ensure documentation specifies 'hyperglycemia' explicitly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic kidney disease, stage 3
N18.3Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Type 2 Diabetes Mellitus with Complications to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.22.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Triggers audits due to vague documentation., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Query for specific glucose control issues, Document A1C and glucose levels clearly
Impact
Reimbursement: May lead to underpayment due to lack of specificity., Compliance: Increases risk of audit due to vague coding., Data Quality: Reduces accuracy of patient records.
Mitigation Strategy
Query provider for specific complication details.
Impact
Coding unspecified complications increases audit risk.
Mitigation Strategy
Ensure all complications are specified and linked to diabetes.
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 with Complications, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Type 2 Diabetes Mellitus with Complications
Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes Mellitus with Complications. These templates include all required elements for proper coding and billing.
Diabetes follow-up with complications
Specialty: EndocrinologyRequired Elements
- Patient's glucose log
- A1C levels
- Foot exam results
- Complication-specific findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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