ICD-10 Coding for Type 2 Diabetes Uncontrolled(E11.65, E11.9)
Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes Uncontrolled. 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 Uncontrolled
E11.0-E11.9Primary Range
Type 2 diabetes mellitus
This range includes codes for type 2 diabetes with various complications, including hyperglycemia.
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 documentation specifies type 2 diabetes with hyperglycemia. |
|
| E11.9 | Type 2 diabetes mellitus without complications | Use when diabetes is documented without complications. |
|
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
Essential facts and insights about Type 2 Diabetes Uncontrolled
Primary ICD-10-CM Codes for type 2 diabetes uncontrolled
Decision Criteria
documentation Criteria
- Documentation must specify hyperglycemia for E11.65.
Applicable To
- Type 2 diabetes with hyperglycemia
- Poorly controlled type 2 diabetes
Clinical Validation Requirements
- HbA1c ≥ 7%
- Fasting glucose ≥ 130 mg/dL
- Random glucose ≥ 200 mg/dL
Code-Specific Risks
- Misuse when 'uncontrolled' is documented without specifying hyperglycemia.
Coding Notes
- Ensure documentation specifies hyperglycemia for accurate coding.
E11.9 - Type 2 diabetes mellitus without complications
Use when diabetes is documented without complications.
Applicable To
- Type 2 diabetes without complications
Excludes
- Type 2 diabetes with complications (E11.0-E11.8)
Clinical Validation Requirements
- Absence of specified complications
Coding Notes
Use for routine management without complications.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.84Differential 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 Uncontrolled to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.65.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect billing.
Mitigation Strategy
Educate providers on documentation requirements, Use templates that prompt for glucose status
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure hyperglycemia is explicitly documented.
Impact
Risk of audits if hyperglycemia is not documented.
Mitigation Strategy
Ensure all documentation includes specific glucose status.
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 Uncontrolled, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Type 2 Diabetes Uncontrolled
Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes Uncontrolled. These templates include all required elements for proper coding and billing.
Endocrinology Progress Note
Specialty: EndocrinologyRequired Elements
- Assessment of diabetes control
- HbA1c levels
- Fasting glucose readings
- Treatment adjustments
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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