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International Classification of Diseases-10 Coding for Diabetes Joy Dugan and Jay Shubrook

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International Classification of Diseases-10 Coding for Diabetes Joy Dugan and Jay Shubrook PRACTICAL POINTERS International Classification of Diseases-10 Coding for Diabetes Joy Dugan and Jay Shubrook ore than 29 million Ameri- new codes and did not include a way cans have diabetes. The Cen- to designate laterality. The ICD-10 Mters for Disease Control and system has 68,000 codes that are Prevention predict that the prevalence three to seven digits each and has the of diabetes will increase from 9% to capacity to expand. >30% in the next 35 years. (1) More In general, ICD-10 codes can be than 21 million offices medical visits/ up to seven characters long and are year are scheduled for diabetes. (2) A designed as follows: XXX.XXX.X total of one in five dollars spent on (category.anatomic site/severity.exten- health care in the United States (and sion). The first set of digits before one in three dollars spent through the first decimal point describes the Medicare) are spent on people with general disease or category. The next diabetes. (3) With this in mind, prop- three digits after the first decimal er and accurate coding for diabetes is point describe the etiology, anatom- a necessity. ical site, severity, or clinical detail. The International Classification Finally, some conditions will have a of Diseases 10th Revision—Clinical Modification (ICD-10) is designed second decimal point, followed by a to accurately classify and categorize final digit that may define an initial or all illnesses and diseases seen in the subsequent encounter, the laterality of U.S. health care setting. (4) The cod- a condition, or the number of weeks’ ing system was updated in October gestation (in the case of pregnancy). 2015 to its tenth revision because it This may seem overly detailed, but was thought that the ninth revision it allows for greater specificity of the (ICD-9) no longer accommodated disease and its state. all of the new codes submitted to the Most codes for diabetes will system, and the ICD-9 codes were require four or five digits to provide not descriptive enough to accurately the level of detail required by ICD-10 reflect the state of patients’ diseases. (5). This article provides key updates For example, the ICD-9 system had for ICD-10 coding for diabetes and its Touro University California College of 13,000 three- to five-digit codes. complications. To make sense of the Osteopathic Medicine Primary Care Department, Vallejo, CA This system was not able to take in coding descriptions, the authors will Corresponding author: Jay Shubrook, TABLE 1. Diagnostic Criteria for Prediabetes* and Diabetes [email protected] Normal Prediabetes Diabetes https://doi.org/10.2337/cd16-0052 Fasting glucose (mg/dL) <100 100–125 ≥126 ©2017 by the American Diabetes Association. Readers may use this article as long as the work Random glucose or OGTT (mg/dL) <140 140–199 ≥200 is properly cited, the use is educational and not A1C (%) 5.7 5.7–6.4 6.5 for profit, and the work is not altered. See http:// < ≥ creativecommons.org/licenses/by-nc-nd/3.0 *For prediabetes, use the “abnormal glucose” code R73.09. for details. CLINICAL DIABETES 1 Clinical Diabetes Online Ahead of Print, published online August 16, 2017 PRACTICAL POINTERS explain them based on the way one TABLE 2. Codes for Type 1 Diabetes With Complications might approach diabetes clinically. Code Used to report type 1 diabetes: ICD-10 Codes for Diabetes E10.1X With the presence of diabetic ketoacidosis For proper coding of diabetes, ICD- 10 codes should reflect the type of di- E10.10 With diabetic ketoacidosis without coma abetes, its current status, and comor- E10.11 With diabetic ketoacidosis with coma bidities of the disease. Compared to E10.2X With renal disease ICD-9, the ICD-10 codes are much E10.21 With diabetic nephropathy more specific. Carefully choosing the E10.22 With diabetic chronic kidney disease most specific ICD-10 codes is import- ant to ensure proper reimbursement. E10.29 With other diabetic kidney E10.3X With eye disease Codes for Screening for Diabetes or Diagnosing E10.311 With ophthalmic complications without macular edema Prediabetes E10.319 With ophthalmic complications with macular edema Screening for Diabetes: Z13.1 E10.321 With mild nonproliferative diabetic retinopathy with macular edema If a person has risk factors for di- abetes and you want to screen him E10.329 With mild nonproliferative diabetic retinopathy without or her for the condition (via glucose macular edema measurement, oral glucose tolerance E10.331 With macular edema test [OGTT], or A1C test), you E10.339 Without macular edema would use a Z code (which indicates E10.341 With severe nonproliferative diabetic retinopathy with screening or prevention services). macular edema Alternatively, using a code that indi- E10.349 With severe nonproliferative diabetic retinopathy without cates the presence of a risk factor for macular edema diabetes is also acceptable for reim- E10.351 With proliferative diabetic retinopathy with macular bursement. The current acceptable edema risk factors include hypertension E10.359 With proliferative diabetic retinopathy without macular (I10) and obesity (E66.XX). edema Prediabetes Diagnosis: R73.09 E10.36 With diabetic cataract If a person has prediabetes, the rec- E10.39 With other diabetic ophthalmic complication ommended ICD-10 code for abnor- E10.4X With nerve disease mal glucose is R73.09, but this code also covers abnormal fasting glucose, E10.40 With diabetic neuropathy, unspecified abnormal glucose tolerance, or an el- E10.41 With diabetic mononeuropathy evated A1C in the prediabetes range E10.42 With diabetic polyneuropathy (Table 1). E10.43 With diabetic autonomic (poly)neuropathy Codes for Known Diabetes E10.44 With diabetic amyotrophy When you are treating a person who E10.49 With other diabetic neurological complication has known diabetes, the first level of distinction is the type of diabetes. E10.5X With peripheral vascular disease Under ICD-9, the main types of dia- E10.51 With diabetic peripheral angiopathy without gangrene betes were coded 250.XX. To properly E10.52 With diabetic peripheral angiopathy with gangrene code for diabetes under ICD-10, four E10.59 With other circulatory complications to five digits are needed. The follow- ing steps will help to ensure accurate E10.6X With diabetes-related musculoskeletal, oral, or skin complications; hypoglycemia; or hyperglycemia diabetes coding: E10.61 With diabetic arthropathy Step 1. Confirm the Type of E10.610 With diabetic neuropathic arthropathy Diabetes The current codes for common forms E10.618 With other diabetic arthropathy of diabetes are: E10.620 With diabetic dermatitis • Type 1 diabetes: E10.XXX E10.621 With foot ulcer • Type 2 diabetes: E11.XXX TABLE CONTINUED ON P. 3 → 2 CLINICAL.DIABETESJOURNALS.ORG Clinical Diabetes Online Ahead of Print, published online August 16, 2017 DUGAN AND SHUBROOK TABLE 2. Codes for Type 1 Diabetes With Complications, • Gestational diabetes mellitus (GDM): O24.429. TABLE 2. Codes forcontinued Type 1 Diabetes from p. With2 Complications Code Used to report type 1 diabetes: There are a number of special cate- E10.622 With other skin ulcer gories of diabetes that have a different pathogenesis from what is known for E10.628 With other skin complications type 1 and type 2 diabetes. These are E10.630 With periodontal disease collectively called “secondary diabe- E10.638 With other oral complications tes” and should not be confused with E10.641 With hypoglycemia with coma type 2 diabetes. For secondary diabe- tes, use the following codes: E10.649 With hypoglycemia without coma or with hypoglycemia unawareness • E08.XXX: “Diabetes due to under- lying condition” is for diabetes E10.65 With hyperglycemia caused by diseases such as can- E10.69 With other specified complication cer, pancreatitis, or nutritional E10.8 With complications, unspecified deficiencies. E10.9 Without complications • E09.XXX: “Drug- or chemical- induced diabetes mellitus” is for TABLE 3. Codes for Type 2 Diabetes With Complications diabetes induced by a drug or toxin. Code Used to report type 2 diabetes with: • E13.XXX: “Other specified diabe- E11.0X With hyperosmolarity tes mellitus” is for genetic defects of E11.0 0 Without nonketotic hyperglycemic hyperosmolar coma β-cell function and insulin action E11.01 With nonketotic hyperglycemic hyperosmolar coma or post-pancreatectomy diabetes. E11.2X With kidney complications Step 2. Describe Whether the E11.21 With diabetic nephropathy Person’s Diabetes Is Currently Well Controlled E11.22 With diabetic chronic kidney disease Level of control is indicated by the E11.29 With other diabetic kidney complications number after the decimal point. If a E11.3X With eye complications person’s diabetes is well controlled, E11.31 With diabetic retinopathy, unspecified that digit will be 9 (i.e., EXX.9). For E11.311 With diabetic retinopathy with macular edema example, a person with type 2 dia- betes that is well controlled who has E11.319 With diabetic retinopathy without macular edema no complications would be indicated E11.32 With mild nonproliferative diabetic retinopathy` by the code E11.9. Likewise, a per- E11.321 With mild nonproliferative diabetic retinopathy with macular son with type 1 diabetes that is well edema controlled who has no complications E11.329 With mild nonproliferative diabetic retinopathy without would be indicated by the code E10.9. macular edema It is important to remember E11.33 With moderate nonproliferative diabetic retinopathy that E11.9 actually describes only a E11.331 With moderate nonproliferative diabetic retinopathy with minority of people with type 2 diabe- macular edema tes. One of the goals of ICD-10 is to better characterize the control of peo- E11.339 With moderate nonproliferative diabetic retinopathy without macular edema ple with diabetes and the specifics of the complications that they are expe- E11.34 With severe nonproliferative diabetic retinopathy riencing.
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