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ICD-10 Coding for Uncontrolled Diabetes(E11.65, E11.649, E11.9)

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

Also known as:

Poorly Controlled DiabetesOut of Control Diabetesdiabetes mellitus uncontrolled

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Related ICD-10 Code Ranges

Complete code families applicable to Uncontrolled Diabetes

E11.0-E11.9Primary Range

Type 2 diabetes mellitus

This range includes codes for 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

CodeDescriptionWhen to UseKey Documentation
E11.65Type 2 diabetes mellitus with hyperglycemiaUse when documentation explicitly links uncontrolled diabetes to hyperglycemia.
  • Documentation of hyperglycemia
  • A1C ≥7% linked to hyperglycemia
  • Fasting glucose ≥126 mg/dL linked to hyperglycemia
E11.649Type 2 diabetes mellitus with hypoglycemia without comaUse when documentation specifies hypoglycemia.
  • Documentation of hypoglycemia
  • Symptoms of low blood sugar episodes
E11.9Type 2 diabetes mellitus without complicationsUse when documentation states 'uncontrolled' without further detail.
  • Lack of specification for hyperglycemia or hypoglycemia

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 diabetes

Essential facts and insights about Uncontrolled Diabetes

The ICD-10 code for uncontrolled diabetes varies: E11.65 for hyperglycemia, E11.649 for hypoglycemia, and E11.9 when unspecified.

Primary ICD-10-CM Codes for uncontrolled diabetes

E11.65
Type 2 diabetes mellitus with hyperglycemia
Billable Code

Decision Criteria

documentation Criteria

  • Explicit mention of hyperglycemia in the patient's record

Applicable To

  • Uncontrolled type 2 diabetes with hyperglycemia
  • Poorly controlled diabetes with elevated glucose

Excludes

  • Type 1 diabetes mellitus with hyperglycemia (E10.65)

Clinical Validation Requirements

  • Documentation of hyperglycemia
  • A1C ≥7% linked to hyperglycemia
  • Fasting glucose ≥126 mg/dL linked to hyperglycemia

Code-Specific Risks

  • Coding without explicit mention of hyperglycemia
  • Assuming hyperglycemia from lab values alone

Coding Notes

  • Ensure hyperglycemia is documented explicitly to use this code.
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 insulin therapy.

Differential Codes

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

Type 2 diabetes mellitus without complications

E11.9
Use when documentation states 'uncontrolled' without specifying hyperglycemia or hypoglycemia.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Uncontrolled 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: Misrepresents the patient's condition., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of reimbursement.

Mitigation Strategy

Review documentation for specific terms., Query provider if documentation is unclear.

Impact

Reimbursement: Incorrect coding can lead to improper reimbursement., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of patient records and data quality.

Mitigation Strategy

Ensure hyperglycemia is explicitly documented or query the provider.

Impact

Risk of audits if hyperglycemia is not documented but coded.

Mitigation Strategy

Ensure all documentation explicitly states hyperglycemia when coding E11.65.

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

Documentation Templates for Uncontrolled Diabetes

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

Uncontrolled diabetes with hyperglycemia

Specialty: Endocrinology

Required Elements

  • Patient's A1C level
  • Fasting glucose levels
  • Symptoms of hyperglycemia

Example Documentation

Patient presents with uncontrolled T2DM with hyperglycemia. A1C is 8.7%, and fasting glucose is 210 mg/dL. Adjusted insulin regimen due to elevated fasting sugars.

Examples: Poor vs. Good Documentation

Poor Documentation Example
68M with T2DM, uncontrolled. Continue metformin.
Good Documentation Example
68M with T2DM with hyperglycemia (A1C 8.7%, glucose 210 mg/dL). Adjusted insulin regimen due to elevated fasting sugars.
Explanation
The good example specifies hyperglycemia and provides lab values, supporting the use of E11.65.

Need help with ICD-10 coding for Uncontrolled Diabetes? Ask your questions below.

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