18 Aug 0
Diabetic coding in ICD-10 has changed significantly from ICD-9. The requirement for documenting the type of diabetes and linking it to any complications still exist. However, in ICD-10, there are very few diabetic codes that require an additional code for the manifestation. Those that do require an additional code are diabetes with CKD and diabetes with a foot ulcer.
ICD-9 and ICD-10 guidelines for coding diabetes require the provider to document diabetes and the complication, ensuring the documentation states a relationship between the diabetes and the complication. For example, diabetes with kidney complications, specifically CKD, would be documented: Diabetes with nephropathy due to diabetes, CKD stage 3, and this would be coded as E11.22 and N18.3. Here, the additional code for the stage of CKD would be required, N18.3.
Diabetes with a diabetic foot or other skin ulcer also requires an additional code for the ulcer. Example: Diabetes with heel ulcer of the right foot, fat layer exposed, would be coded E11.621 and L97.412. Note the additional code for the ulcer and the increase in specificity with this diagnosis. Documentation of laterality and degree of ulcer are both required to properly code this diagnosis. Unspecified codes are still present in ICD-10, however, it is best practice to document, and ultimately code, to the highest specificity.
Documenting only “diabetes with renal manifestations” or “diabetes with neurologic manifestations”, etc. does not best support documenting diabetic complications, is not complete documentation, and is not recommended. This type of documentation does not distinguish a link, or relationship, between the diabetes and the manifestation or complication. ICD-10 makes this easier with the combination codes. Examples of some of the combination codes for diabetes are as follows:
- Diabetes, type 2, with diabetic polyneuropathy-E11.42
- Diabetes, type 2, with mild non-proliferative diabetic retinopathy without macular edema- E11.321
- Diabetes, type 2, with diabetic peripheral angiopathy without gangrene- E11.51
- Diabetes, type 2, with Charcot’s joints- E11.610
Currently, HCC mapping has not changed for diabetes and diabetic complications in ICD-10. Despite the change to combination codes for diabetes with complications, the additional HCC for certain complications will still be applied. Example: Diabetes with diabetic polyneuropathy, E11.42, while only one ICD-10 code, still maps to HCC’s 18 and 75.
Another notable change in coding diabetes in ICD-10 is the elimination of the code for “uncontrolled” diabetes. To properly document diabetes, formerly documented as uncontrolled, the documentation must now state diabetes with hyperglycemia or diabetes with hypoglycemia.