ICD-10 and Documenting Diabetes

ICD-10 and Documenting Diabetes

  • 16 Feb Off
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ICD-10 brought many changes to diagnosis coding, diabetes being one of them, exploding to over 200 codes. These codes are largely combination codes – meaning, if a causal relationship is stated between the type of diabetes and a complication – usually only one code is needed to describe that relationship.  In ICD-9, two codes were required to describe the complication: one for the type of diabetes and one for the complication.

In ICD-10, diagnoses of diabetes are classified to one of five categories: E08 Diabetes mellitus due to underlying conditions; E09 Drug or chemical induced diabetes mellitus; E10 Type 1 diabetes mellitus; E11 Type 2 diabetes mellitus; and E13 other specific diabetes mellitus. 

As stated previously, in ICD-10, most diabetes codes do not require an additional code to describe the complication. However, there are a few exceptions.  One exception is diabetes with CKD. Here, coding guidelines ask for the specific stage of CKD to be specified. Therefore, DM type 2 with CKD stage 3 would be coded E11.22 and N18.3. 

Also, the description of the complications in ICD-10 are much more specific than in ICD-9. An example is diabetes with kidney complications.  Two of the most commonly diagnosed kidney complications are chronic kidney disease (CKD) and diabetic nephropathy.  Diabetic nephropathy is diagnosed, and typically manifests as, microalbuminuria.   At least two of three elevated albumin to creatinine ratios (>30 mcg/mg) should be present before making a diagnosis of microalbuminuria. While nephropathy does mean kidney disease, it is not to be used interchangeably with CKD.  The examples of kidney complications are:  E11.21 type 2 DM with diabetic nephropathy, type 2 DM with intercapillary glomerulosclerosis, type 2 DM with intracapillary glomerulosclerosis, or type 2 DM with kimmelstiel-Wilson disease.  This means that providers must document more completely to describe the complication of diabetes.  If the type of diabetes is not documented, the default is E11.9: type 2 DM (without complications).  If the type of diabetes is not noted, and the patient is on insulin, this also defaults to E11.9 (without complications).  By not documenting the type of diabetes mellitus, and the complications, if any, it can lead to an ICD 10 code mapping to a HCC with a lesser value

There is also a code for long term current use of insulin (as there as in ICD-9): Z79.4.  If a patient is on long term insulin it is important to document this as well.

New categories of DM complications were also added to ICD-10:   DM with skin complications, DM with oral complications, and DM with arthropathy.

Being a combination code also means that by documenting and linking diabetes with its complication that this ICD 10 code will automatically map to two HCC’s: Complicated Diabetes plus the Complication HCC. For example, DM type 2 with diabetic neuropathy, E11.40, maps to both HCC 18 and HCC 75.

Clear, concise documentation has always been the key to proper coding and reimbursement. However, it is now more critical that the relationship between the DM and the complication clearly be stated; this will ensure correct coding and proper treatment for the participant.   It will also reflect the right reimbursement for a risk population. 

Focus documentation on the type or etiology of the diabetes, the body system affected, and any complications affecting the body system.