By Judy Monestime bio
Chapter 4 in ICD-10 CM contains codes for endocrine, nutritional and metabolic diseases (E00-E89). The chapter includes frequently coded conditions such as disorders of the thyroid gland, obesity, dehydration, and diabetes mellitus.
This chapter contains the following blocks:
E00-E07 Disorders of thyroid gland
E08-E13 Diabetes mellitus
E15-E16 Other disorders of glucose regulation and pancreatic internal secretion
E20-E35 Disorders of other endocrine glands
E36 Intraoperative complications of endocrine system
E40-E46 Malnutrition
E50-E64 Other nutritional deficiencies
E65-E68 Overweight, obesity and other hyperalimentation
E70-E88 Metabolic disorders
E89 Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified
There are five diabetes mellitus categories in ICD-10-CM. The diabetes mellitus categories E08–E13 are further subdivided into four- or five-character subcategories. When a category has been subdivided into four-, five-, or six-character codes, the diabetes code assigned represents the highest level of specificity within ICD-10-CM.
Diabetes Mellitus (E08-E13)
E08, Diabetes mellitus due to underlying condition
E09, Drug or chemical induced diabetes mellitus
E10, Type 1 diabetes mellitus
E11, Type 2 diabetes mellitus
E13, Other specified diabetes mellitus
Diabetes mellitus tabular inclusions notes are introduced by the term “Includes” and appear at the beginning of a category. Categories E10–E13 inclusion notes further define or provide examples of the content within each category, as illustrated below.
In ICD-10-CM, diabetes mellitus tabular inclusion notes are introduced by the term “Includes” and appear at the beginning of a category. The “Excludes1” note, meaning “Not coded here,” appears under all the diabetes mellitus categories. An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.
E10, Type 1 diabetes mellitus
Excludes1:
- Diabetes mellitus due to underlying condition (E08.-)
- Drug or chemical induced diabetes mellitus (E09.-)
- Gestational diabetes (O24.4-)
- Hyperglycemia NOS (R73.9)
- Neonatal diabetes mellitus (P70.2)
- Postpancreatectomy diabetes mellitus (E13.-)
- Postprocedural diabetes mellitus (E13.-)
- Secondary diabetes mellitus NEC (E13.-)
- Type 2 diabetes mellitus (E11.-)
E13, Other specified diabetes mellitus
Includes:
- Diabetes mellitus due to genetic defects of beta-cell function
- Diabetes mellitus due to genetic defects in insulin action
- Postpancreatectomy diabetes mellitus
- Postprocedural diabetes mellitus
- Secondary diabetes mellitus NEC
ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by reporting diabetes mellitus by type, with hyperglycemia. The diabetes mellitus codes are combination codes that include the following:
- Type of diabetes (type 1, type 2, due to underlying condition or due to drug or chemical)
- Body system affected
- Complications affecting that body system
Let’s practice! How do you code the following encounter?
A 72-year-old female is being seen for mild nonproliferative diabetic retinopathy with
macular edema. She has type 2 DM and takes insulin on a daily basis. She also has
diabetic cataract in his right eye. What diagnoses codes would the physician report?
- E11.321 Diabetes, diabetic (mellitus) (sugar), type 2, with, retinopathy, nonproliferative, mild, with macular edema
- E11.36 Diabetes, diabetic (mellitus) (sugar), type 2, with, cataract
- Z79.4 Long-term (current) (prophylactic) drug therapy (use of), insulin
Rationale: There is a combination code for the type 2 diabetes with nonproliferative diabetic retinopathy with macular edema. The diabetic cataract was documented and should be coded, but it requires a separate code. Since the patient has type 2 DM, and is on insulin, code Z79.4 should be assigned to indicate that as indicated by the note at category E11: Use additional code to identify any insulin use (Z79.4).
Judy Monestime, MBA, CDIP, CPC, and AHIMA ICD-10 CM/PCS Trainer/Ambassador, is an executive healthcare consultant, keynote speaker, and writer.
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