ICD-10 Coding for Uncontrolled Type 2 Diabetes Mellitus(E11.65, E11.649)
Complete ICD-10-CM coding and documentation guide for Uncontrolled Type 2 Diabetes Mellitus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Uncontrolled Type 2 Diabetes Mellitus
E11.0-E11.9Primary Range
Type 2 diabetes mellitus
This range includes all codes related to type 2 diabetes mellitus, including those with complications such as hyperglycemia and hypoglycemia.
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 hyperglycemia is documented in type 2 diabetes. |
|
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma | Use when hypoglycemia is documented in 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 uncontrolled type 2 diabetes mellitus
Essential facts and insights about Uncontrolled Type 2 Diabetes Mellitus
Primary ICD-10-CM Codes for type 2 diabetes mellitus uncontrolled
Decision Criteria
clinical Criteria
- HbA1c ≥7% or fasting glucose ≥130 mg/dL
documentation Criteria
- Explicit mention of hyperglycemia
Applicable To
- Poorly controlled type 2 diabetes
- Type 2 diabetes with hyperglycemia
Excludes
- Type 1 diabetes mellitus with hyperglycemia
Clinical Validation Requirements
- HbA1c ≥7%
- Fasting glucose ≥130 mg/dL
- Explicit documentation of hyperglycemia
Code-Specific Risks
- Misuse when hyperglycemia is not documented
Coding Notes
- Ensure hyperglycemia is explicitly documented to use E11.65.
E11.649 - Type 2 diabetes mellitus with hypoglycemia without coma
Use when hypoglycemia is documented in type 2 diabetes.
Applicable To
- Type 2 diabetes with hypoglycemia
Excludes
- Type 1 diabetes mellitus with hypoglycemia
Clinical Validation Requirements
- Blood glucose <70 mg/dL
- Symptoms of hypoglycemia
Coding Notes
Ensure hypoglycemia is explicitly documented to use E11.649.
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 Uncontrolled Type 2 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: Leads to misinterpretation of patient's condition., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Educate providers on documentation requirements, Use templates that prompt for specific details
Impact
Reimbursement: Incorrect coding can lead to improper reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query provider for clarification or use E11.9 if hyperglycemia is not documented.
Impact
Risk of audits due to vague documentation of diabetes control status.
Mitigation Strategy
Ensure documentation explicitly states control status and related lab values.
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 Uncontrolled Type 2 Diabetes Mellitus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Uncontrolled Type 2 Diabetes Mellitus
Use these documentation templates to ensure complete and accurate documentation for Uncontrolled Type 2 Diabetes Mellitus. These templates include all required elements for proper coding and billing.
Outpatient visit for diabetes management
Specialty: EndocrinologyRequired Elements
- Type of diabetes
- Control status
- Complications
- Lab results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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