ICD-10 Coding for Type 2 Diabetes(E11.9, E11.65)
Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes. 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
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.9 | Type 2 diabetes mellitus without complications | Use when type 2 diabetes is well-controlled without any complications. |
|
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Use when type 2 diabetes is uncontrolled with hyperglycemia. |
|
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 hyperglycemia
Essential facts and insights about Type 2 Diabetes
Primary ICD-10-CM Codes for diabetic type 2
Decision Criteria
clinical Criteria
- Patient's A1C is ≤7% and no complications are documented.
Applicable To
- Well-controlled type 2 diabetes
Excludes
- Type 1 diabetes mellitus (E10.-)
Clinical Validation Requirements
- A1C ≤7%
- Fasting glucose <126 mg/dL
Code-Specific Risks
- Risk of undercoding if complications are present but not documented.
Coding Notes
- Ensure no complications are present before using this code.
E11.65 - Type 2 diabetes mellitus with hyperglycemia
Use when type 2 diabetes is uncontrolled with hyperglycemia.
Applicable To
- Uncontrolled type 2 diabetes
Excludes
- Type 1 diabetes mellitus with hyperglycemia (E10.65)
Clinical Validation Requirements
- A1C >7%
- Fasting glucose >126 mg/dL
Coding Notes
Document hyperglycemia with specific lab values.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Type 2 Diabetes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.9.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Always specify type 2 diabetes in documentation.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts the accuracy of patient records.
Mitigation Strategy
Use specific codes for complications such as E11.65 for hyperglycemia.
Impact
Lack of specific details in diabetes documentation.
Mitigation Strategy
Implement regular documentation audits.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Type 2 Diabetes
Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes. These templates include all required elements for proper coding and billing.
Primary care management of type 2 diabetes
Specialty: Primary CareRequired Elements
- Patient's A1C level
- Current medications
- Presence of complications
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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