Uncontrolled Diabetes ICD-10: Guide for Endocrinologists

Accurate diabetes mellitus coding is essential for endocrinologists to thrive in today’s world. It adds clinical clarity, billing accuracy, and optimal patient management in practice. ICD-10-CM stands for International Classification of Diseases, 10th Revision, Clinical Modification. In the United States, the ICD system provides specific codes to describe various symptoms of diabetes mellitus, including poorly controlled or inadequately managed conditions. As per the ICD-10 code shared by the NLM, instead of ‘uncontrolled diabetes,’ the accurate codes are E11.65 and E11.64, indicating Type 2 hyperglycemia and hypoglycemia, respectively. The following are some key codes for diabetes mellitus, including the ‘Uncontrolled Diabetes ICD-10 code.’

Understanding “Uncontrolled” Diabetes in ICD-10

In ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification), the word “uncontrolled” does not appear as an independent diagnosis. Instead, diabetes is classified based on its type and the presence of complications or manifestations. For instance, the ICD-10 for uncontrolled type 2 diabetes, known as Type 2 diabetes mellitus with hyperglycemia, would be E11.65. This specific code reflects glycemic control deficiency rather than labelling the condition as “uncontrolled”.

Key ICD-10 Codes for Diabetes Mellitus

Diabetes Type	ICD-10 Code	Description
Type 1	E10	Type 1 diabetes mellitus
Type 2	E11	Type 2 diabetes mellitus
Unspecified	E11.9	Type 2 diabetes mellitus without complications
With Hyperglycemia	E11.65	Type 2 diabetes mellitus with hyperglycemia
With Hypoglycemia	E11.64	Type 2 diabetes mellitus with hypoglycemia
With Other Specified Complications	E11.6	Type 2 diabetes mellitus with other specified complications
With Unspecified Complications	E11.8	Type 2 diabetes mellitus with unspecified complications

Addressing Hyperglycemia and Hypoglycemia in Coding

When documenting diabetes with symptoms such as hyperglycemia or hypoglycemia, it’s crucial to use the appropriate combination codes:

• Hyperglycemia: ICD 10 code type 2 diabetes with hyperglycemia is E11.65.
• Hypoglycemia: For Type 2 diabetes hypoglycemia, ICD is E11.64.

These codes provide a more precise description of the patient’s condition compared to the outdated “uncontrolled” label.  

Impact on Insurance Claims and Reimbursement

Accurate coding is essential for insurance claims processing. Using precise ICD-10 codes ensures that the healthcare provider’s documentation aligns with the services provided. This not only facilitates appropriate reimbursement but can solidify your practice’s finances with the help of faster claims. For example, Medicare covers diabetes screening when billed with diagnosis code Z13.1, which is the ICD-10-CM code for encounter for screening for diabetes mellitus. Still Using Blood Glucose Meters? It’s time to get rid of repeated finger pricks just to check blood glucose. Get a free benefit check now and claim your continuous glucose monitoring system (CGM system) today!

CMS Guidelines on Diabetes Coding

The Centres for Medicare & Medicaid Services (CMS) provides specific guidance on coding diabetes mellitus:

• ICD-10 does not support the “Uncontrolled” diabetes concept anymore. Poorly controlled diabetes should indicate whether it’s hyperglycemia or hypoglycemia, and be coded accordingly.
• Diabetic indicators are combined into the primary code for Diabetes Mellitus (combination codes). For example, diabetes with nephropathy is a combination code.

Conclusion

Instead of uncontrolled diabetes, the accurate ICD 10 code type 2 diabetes with hyperglycemia is E11.65. Accurate coding of diabetes mellitus in ICD-10-CM is essential for effective patient management and proper reimbursement. By utilising specific codes that reflect the patient’s condition, healthcare providers can ensure clear communication and appropriate care with the insurance companies, enjoy better cash flow, leading to a higher probability of expanding their practices. Minimise the pain of your diabetic patients with the help of CGMS, e.g., Freestyle Libre 3 Plus sensors.