ICD-10 Coding for Uncontrolled Type 2 Diabetes(E11.65)
Complete ICD-10-CM coding and documentation guide for Uncontrolled Type 2 Diabetes. 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
E11.0-E11.9Primary Range
Type 2 Diabetes Mellitus
This range includes all codes related to type 2 diabetes, including those with complications such as hyperglycemia.
Key Information: ICD-10 code for uncontrolled diabetes type 2
Essential facts and insights about Uncontrolled Type 2 Diabetes
Primary ICD-10-CM Code for uncontrolled diabetes type 2
Decision Criteria
clinical Criteria
- Presence of hyperglycemia symptoms and lab results
documentation Criteria
- Provider documentation explicitly states hyperglycemia
Applicable To
- Uncontrolled type 2 diabetes with hyperglycemia
Excludes
- Type 1 diabetes mellitus with hyperglycemia
Clinical Validation Requirements
- HbA1c ≥7%
- Fasting glucose >130 mg/dL
- Symptoms such as polyuria or polydipsia
Code-Specific Risks
- Incorrectly coding as E11.9 when hyperglycemia is present but not documented.
Coding Notes
- Ensure hyperglycemia is explicitly documented by the provider.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of insulin
Z79.84Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Uncontrolled Type 2 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: Misrepresentation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Reduced reimbursement due to incorrect DRG assignment.
Mitigation Strategy
Educate providers on documentation requirements., Implement documentation checklists.
Impact
Reimbursement: Potential loss of MCC status affecting DRG reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query the provider for clarification on hyperglycemia.
Impact
Risk of audits if hyperglycemia is not documented but coded.
Mitigation Strategy
Regular audits of documentation practices.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Uncontrolled Type 2 Diabetes
Use these documentation templates to ensure complete and accurate documentation for Uncontrolled Type 2 Diabetes. These templates include all required elements for proper coding and billing.
Endocrinology Clinic Visit
Specialty: EndocrinologyRequired Elements
- Diagnosis of type 2 diabetes
- Documentation of hyperglycemia
- HbA1c and glucose levels
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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