ICD-10 Coding for HbA1c(E11.65, R73.09)
Complete ICD-10-CM coding and documentation guide for HbA1c. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to HbA1c
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.65 | Type 2 diabetes mellitus with hyperglycemia | Use when a patient with type 2 diabetes has an A1c level indicating hyperglycemia. |
|
| R73.09 | Other abnormal glucose | Use for patients with prediabetes or other abnormal glucose findings. |
|
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 HbA1c
Essential facts and insights about HbA1c
Primary ICD-10-CM Codes for hga1c
Decision Criteria
clinical Criteria
- A1c >7% with symptoms
Applicable To
- Type 2 diabetes with high blood sugar
Excludes
- Type 1 diabetes mellitus (E10.-)
Clinical Validation Requirements
- A1c >7%
- Symptoms of hyperglycemia
Code-Specific Risks
- Incorrectly coding without documented hyperglycemia
Coding Notes
- Ensure hyperglycemia is explicitly documented.
R73.09 - Other abnormal glucose
Use for patients with prediabetes or other abnormal glucose findings.
Applicable To
- Prediabetes
Excludes
- Diabetes mellitus (E08-E13)
Clinical Validation Requirements
- A1c 5.7-6.4%
Coding Notes
Ensure prediabetes is documented with specific A1c values.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of oral hypoglycemic drugs
Z79.84Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting HbA1c to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.
Impact
Clinical: Impacts treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Use specific terms like 'hyperglycemia' with A1c values.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces accuracy of health records.
Mitigation Strategy
Query provider for specific documentation of diabetes type and complications.
Impact
Failure to document complications can lead to audit issues.
Mitigation Strategy
Ensure all complications are documented with specific codes.
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 HbA1c, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for HbA1c
Use these documentation templates to ensure complete and accurate documentation for HbA1c. These templates include all required elements for proper coding and billing.
Diabetes management with hyperglycemia
Specialty: EndocrinologyRequired Elements
- Patient details
- A1c test results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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