ICD-10 Coding for Hyperglycemia due to Diabetes Mellitus(E11.65)
Complete ICD-10-CM coding and documentation guide for Hyperglycemia due to Diabetes Mellitus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hyperglycemia due to Diabetes Mellitus
Key Information: ICD-10 code for hyperglycemia due to diabetes mellitus
Essential facts and insights about Hyperglycemia due to Diabetes Mellitus
Primary ICD-10-CM Code for hyperglycemia due to diabetes mellitus
Decision Criteria
clinical Criteria
- Presence of elevated glucose levels and symptoms in a diabetic patient.
documentation Criteria
- Explicit mention of hyperglycemia in the context of diabetes.
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 with symptoms
- A1C ≥6.5%
Code-Specific Risks
- Misclassification if hyperglycemia is not documented as related to diabetes.
Coding Notes
- Ensure hyperglycemia is specifically documented as a complication of diabetes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Type 2 diabetes mellitus with unspecified complications
E11.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Hyperglycemia, unspecified
R73.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hyperglycemia due to Diabetes Mellitus 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 inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Ensure documentation links hyperglycemia to diabetes., Use specific ICD-10 codes.
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects the accuracy of patient records and data analytics.
Mitigation Strategy
Query the provider to specify if 'uncontrolled' refers to hyperglycemia.
Impact
Failure to document hyperglycemia as a complication can lead to audit issues.
Mitigation Strategy
Regular training on documentation and coding updates.
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 Hyperglycemia due to Diabetes Mellitus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hyperglycemia due to Diabetes Mellitus
Use these documentation templates to ensure complete and accurate documentation for Hyperglycemia due to Diabetes Mellitus. These templates include all required elements for proper coding and billing.
Outpatient management of type 2 diabetes with hyperglycemia
Specialty: EndocrinologyRequired Elements
- Patient's blood glucose readings
- A1C levels
- Symptoms of hyperglycemia
- Treatment adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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