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Icd 10 Code For Diabetes Mellitus Type 2 Uncontrolled

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Correctly Coding: Diabetes Mellitus

When selecting International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health. A joint effort between the healthcare provider and the coder/biller is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Diabetes mellitus is one of the most inaccurately coded chronic conditions. Many billers/coders/providers are missing opportunities to show which patients are sicker and are at a higher risk. The prevalence of diabetes mellitus and the complexity of diabetes coding require a solid understanding of the ICD-10 coding guidelines to ensure accurate code assignment. These diagnosis codes are also used in determining the eligible population for the Comprehensive Diabetes Care quality measure and the threshold the member is held to in order to be in control for the Controlling High Blood Pressure quality measure. ICD-10 Category E11* Diabetes Mellitus: Tips on How to Code using ICD-10 Codes Diabetes Mellitus is an HCC (Hierarchical Condition Category) The diabetes mellitus codes are combination codes that include: 1. The type of diabe Continue reading >>

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Popular Questions

  1. asmith79

    I am looking for any information on coding Diabetes, Type 2, uncontrolled for ICD 10. In a recent educational discussion there was some confusion on which was the appropriate code to use, E11.9 or E11.65. The thought behind E11.65 is that the terms "uncontrolled" and "out of control" have the same meaning. When you look in the alpha index under diabetes, out of control, ( page 95) , it directs you to code "Diabetes, specificed type, with hyperglycemia" which would take you to E11.65.
    During the discussion some argued that the terms "uncontrolled" and "inadequately controlled" or "out of control" did not have the same meaning. Does any one have any documentation supporting or disputing this?
    Also, it was brought up that since our chart just said "uncontrolled" how could we use the code E11.65 since it specifically stated hyperglycemia? Is there any documentation out there stating that "uncontrolled" diabetes refers to hyperglycemia?
    Anything would be appreciated!
    Thanks!!!
    Angela Smith CPC, CFPC, COBGC

  2. BenCrocker

    Found this: http://journal.ahima.org/2012/05/16/...n-icd-10-cm-4/ Apparently ICD 10 doesn't use the term UNCRONTROLLED anymore. It's either inadequately controlled, Out of control, or Poorly controlled.

  3. mitchellde

    Originally Posted by BenCrocker
    Found this: http://journal.ahima.org/2012/05/16/...n-icd-10-cm-4/ Apparently ICD 10 doesn't use the term UNCRONTROLLED anymore. It's either inadequately controlled, Out of control, or Poorly controlled. The problem I have with articles like this is that this is someone's version or opinion and they wrote an article. At no time is an official source cited for that statement. I agree that diabetes with hyperglycemia is an out of control disease process, however I do not agree that just because the provider documents "uncontrolled", that this is always what they are referencing. In other words a diabetic patient that does not always adhere to proper diet or does not take the insulin correctly, while they may not yet be hyperglycemic, the provider may document the diabetes is poorly controlled. The coding guidelines do not direct us to code uncontrolled status as diabetes with hyperglycemia. And the classification does not have a listing for diabetes, uncontrolled, or uncontrolled, diabetes. Without an official source, I will default to , if the provider does not state diabetes with hyperglycemia, then it cannot be coded that way.
    Another point to consider on this, an endocrinologist once told me that the reason the ICD-9 classification choices state, uncontrolled, or not stated as uncontrolled instead of uncontrolled vs controlled, is that diabetes is truly never in a "controlled" state and the reason this is not stated this way in ICD-10 CM is because the physician does not need to document this, it is understood that the reason we monitor the diabetic patient as closely as we do is because they are never truly under control. He had a lot more to say on this subject and it does make sense.
    So I would hesitate to put stock in an article that makes a bold statement but does not back it up.

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