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ICD-10 Coding for Type 2 Diabetes Mellitus(E11.9, E11.65)

Complete ICD-10-CM coding and documentation guide for Type 2 Diabetes Mellitus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

T2DMAdult-onset diabetesNon-insulin-dependent diabetesDiabetes Type IIDiabetes Type 2Non-Insulin Dependent Diabetes Mellitus (NIDDM)Diabetes Mellitus Type 2Non-Insulin Dependent Diabetes MellitusNIDDMNon-insulin-dependent diabetes mellitusDM IIType II Diabetesdmiinoninsulindependent diabetes mellitus niddm

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Related ICD-10 Code Ranges

Complete code families applicable to Type 2 Diabetes Mellitus

E11Primary Range

Type 2 diabetes mellitus

Primary code range for type 2 diabetes, covering various complications and manifestations.

Z79

Long-term (current) drug therapy

Used for documenting long-term use of insulin or oral hypoglycemic drugs in diabetes management.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
E11.9Type 2 diabetes mellitus without complicationsUse when type 2 diabetes is diagnosed without any documented complications.
  • Diagnosis of diabetes with no specified complications
  • HbA1c ≥6.5% or fasting glucose ≥126 mg/dL
E11.65Type 2 diabetes mellitus with hyperglycemiaUse when hyperglycemia is documented in a patient with type 2 diabetes.
  • Fasting glucose ≥126 mg/dL or random glucose ≥200 mg/dL
  • Documented hyperglycemia

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 type 2 diabetes

Essential facts and insights about Type 2 Diabetes Mellitus

The ICD-10 code for type 2 diabetes without complications is E11.9. For type 2 diabetes with hyperglycemia, use E11.65.

Primary ICD-10-CM Codes for type 2 diabetes

E11.9
Type 2 diabetes mellitus without complications
Billable Code

Decision Criteria

clinical Criteria

  • No complications documented

Applicable To

  • Type 2 diabetes mellitus NOS

Excludes

  • Type 1 diabetes mellitus (E10.-)
  • Secondary diabetes mellitus (E08-E09)

Clinical Validation Requirements

  • Diagnosis of diabetes with no specified complications
  • HbA1c ≥6.5% or fasting glucose ≥126 mg/dL

Code-Specific Risks

  • Risk of undercoding if complications are present but not documented.

Coding Notes

  • Ensure no complications are documented before using E11.9.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Long-term (current) use of insulin

Z79.4
Use when the patient is on long-term insulin therapy.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Type 1 diabetes mellitus without complications

E10.9
Type 1 diabetes is insulin-dependent and usually diagnosed in younger patients.

Type 2 diabetes mellitus without complications

E11.9
E11.65 requires documented hyperglycemia.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Type 2 Diabetes Mellitus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.9.

Impact

Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Always check for specific codes., Educate staff on documentation specificity.

Impact

Reimbursement: Incorrect coding can lead to underpayment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Use E11.65 when hyperglycemia is present.

Impact

Incorrect coding of diabetes complications can lead to audits.

Mitigation Strategy

Ensure documentation clearly links complications to diabetes.

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 Mellitus, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Type 2 Diabetes Mellitus

Use these documentation templates to ensure complete and accurate documentation for Type 2 Diabetes Mellitus. These templates include all required elements for proper coding and billing.

Type 2 diabetes with hyperglycemia

Specialty: Endocrinology

Required Elements

  • Patient's blood glucose levels
  • A1C results
  • Medication adjustments

Example Documentation

Patient presents with type 2 diabetes and hyperglycemia. A1C is 8.5%. Adjusting insulin dosage to manage glucose levels.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has uncontrolled diabetes.
Good Documentation Example
Patient has type 2 diabetes with hyperglycemia, A1C 8.5%.
Explanation
The good example specifies the type of diabetes and the presence of hyperglycemia.

Need help with ICD-10 coding for Type 2 Diabetes Mellitus? Ask your questions below.

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