ICD-10 Coding for Poorly Controlled Diabetes(E11.65)
Complete ICD-10-CM coding and documentation guide for Poorly Controlled Diabetes. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Poorly Controlled Diabetes
E08-E13Primary Range
Diabetes mellitus
This range includes all types of diabetes mellitus, including Type 2 with hyperglycemia.
Key Information: ICD-10 code for poorly controlled diabetes
Essential facts and insights about Poorly Controlled Diabetes
Primary ICD-10-CM Code for poorly controlled diabetes
Decision Criteria
clinical Criteria
- Documented hyperglycemia with Type 2 diabetes
documentation Criteria
- Provider notes indicating 'poorly controlled' or 'out of control' diabetes
Applicable To
- Poorly controlled diabetes
- Out of control diabetes
Clinical Validation Requirements
- Fasting glucose >130 mg/dL
- Random glucose >180 mg/dL
- HbA1c ≥7% with symptoms
Code-Specific Risks
- Using without current hyperglycemia documentation
- Misinterpreting lab values without provider confirmation
Coding Notes
- Ensure hyperglycemia is documented by the provider, not inferred from lab values alone.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.4Differential 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 Poorly Controlled Diabetes to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.
Impact
Clinical: Leads to ambiguous clinical records., Regulatory: May result in coding errors., Financial: Potential for claim denials.
Mitigation Strategy
Specify type of diabetes and control status., Use precise terminology in documentation.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure provider documents hyperglycemia explicitly.
Impact
Risk of coding errors if hyperglycemia is not documented.
Mitigation Strategy
Ensure provider documentation includes hyperglycemia.
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 Poorly Controlled Diabetes, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Poorly Controlled Diabetes
Use these documentation templates to ensure complete and accurate documentation for Poorly Controlled Diabetes. These templates include all required elements for proper coding and billing.
Diabetes management visit
Specialty: EndocrinologyRequired Elements
- Assessment of diabetes control
- Documentation of hyperglycemia
- Medication adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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