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The National Center for Health Statistics (NCHS), the federal agency responsible for use of the ICD-10, has developed a clinical modification of the classification for morbidity purposes and guidelines for coding and reporting. Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use. The effective implementation date for ICD-10-CM (and ICD-10-PCS [Procedure Coding System]) is October 1, 2013. Updates to this version are anticipated prior to implementation of ICD-10-CM.
There are six diabetes mellitus categories in the ICD-10-CM. They are:
•E08 Diabetes mellitus due to an underlying condition
•E09 Drug or chemical induced diabetes mellitus
•E10 Type I diabetes mellitus
•E11 Type 2 diabetes mellitus
•E13 Other specified diabetes mellitus
•E14 Unspecified diabetes mellitus
All the categories above (with the exception of E10) include a note directing users to use an additional code to identify any insulin use, which is Z79.7. The concept of insulin and noninsulin is a component of the diabetes mellitus categories in ICD-10-CM. Code Z79.7 (long-term current use of insulin) is added to identify the use of insulin for diabetic management, even if the patient is not insulin-dependent in code categories E08 to E09 and E11 to E14. The fourth character under these categories refers to underlying conditions with specified complications, whereas the fifth character defines the specific manifestation such as neuropathy, angiopathy, and other conditions. Definitions for the types of diabetes mellitus are included in the “includes notes” under each diabetes mellitus category. Sequencing of diabetes codes from categories E08 to E09 have a “code first” note indicating that diabetes is to be sequenced after the underlying condition, drug, or chemical that is responsible for the diabetes. Codes from categories E10 to E14 (diabetes mellitus) are sequenced first, followed by B codes for any additional complications outside of these categories, if applicable.
The guidelines for coding and reporting in ICD-10-CM are as follows:
•Type of diabetes
○The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason type 1 diabetes mellitus is also referred to as juvenile diabetes.
○If the type of diabetes mellitus is not documented in the medical record the default is E11.x, Type 2 diabetes mellitus.
•Diabetes mellitus and the use of insulin
○If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11, Type 2 diabetes mellitus. Additionally, type 2 patients who routinely use insulin, code Z79.4, Long-term (current) use of insulin should also be assigned to indicate that the patient uses insulin.
○Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient's serum glucose level under control during an encounter.
•Diabetes mellitus in pregnancy
○Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should be assigned a code O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08–E13).
•Gestational (pregnancy-induced) diabetes
○Gestational (pregnancy-induced) diabetes can occur during the second and third trimester of pregnancy in women who were not diabetic prior to pregnancy. Gestational diabetes can cause complications in the pregnancy similar to those of pre-existing diabetes mellitus.
○Codes for gestational diabetes are in subcategory O24.4, Gestational diabetes mellitus. No other code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, should be used with a code from O24.4.
○The codes under subcategory O24.4 include diet-controlled and insulin-controlled treatment. If a patient with gestational diabetes is treated with both diet and insulin, only the code for insulin-controlled is required.
○Code Z79.4, Long-term (current) use of insulin, should not be assigned with codes from subcategory O24.4.
○An abnormal glucose tolerance in pregnancy is assigned a code from subcategory O99.81, Abnormal glucose complicating pregnancy, childbirth, and the puerperium.
•Complications due to insulin pump malfunction
○An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6, Mechanical complication of other specified internal and external prosthetic devices, implants, and grafts, which specifies the type of pump malfunction, as the principal or first listed code, followed by code T38.3×6-, Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.
○The principal or first listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin should also be T85.6-, Mechanical complication of other specified internal and external prosthetic devices, implants, and grafts, followed by code T38.3×1-, Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, accidental (unintentional).
•Secondary diabetes mellitus
○Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).
○Codes under category E08, Diabetes mellitus due to underlying condition, and E09, Drug or chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus.
○For postpancreatectomy diabetes mellitus (lack of insulin due to the surgical removal of all or part of the pancreas), assign code E89.1, Postsurgical hypoinsulinemia. Assign a code from category E08 and code Z79.4, Other acquired absence of organ, as additional codes.
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Reference
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Centers for Disease Control and Prevention
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International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM): 2010 update of ICD-10-CM
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Available at: http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
In the 2010 release of International Statistical Classification of Diseases and Related Health Problems, 10th revision, Clinical Modification (ICD-10-CM),1 there are a total of 318 codes for diabetes mellitus, including gestational diabetes mellitus. The reason for the large number of codes is that ICD-10-CM combines multiple disease classes into a single code. The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter.
PII: S1555-4155(10)00211-4
doi:10.1016/j.nurpra.2010.04.001
© 2010 American College of Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
