The official changes made to ICD-10-CM coding and reporting guidelines for diabetes mellitus and secondary diabetes mellitus.

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in ICD-10-CM
–Important Guidelines
Coding Diabetes
Mellitus
The official changes
made to ICD-10-CM
coding and reporting
guidelines for diabetes
mellitus and
secondary diabetes
mellitus.
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Regarded as one of the most complicated diseases, diabetes is a growing concern
both in the United States and across the world. During the month of November, the
Centers for Medicare and Medicaid Services (CMS) is raising awareness and
educating communities about the escalating health threat posed by diabetes,
diabetic eye disease and the importance of early detection and related preventive
health services covered by Medicare. Diabetes is a complicated health condition
that affects about 382 million people worldwide. It is estimated that by the end of
2040, more than 640 million people will be living with this chronic disease.
Currently, 3.6 million Americans aged 40 and older suffer from diabetic eye
disease. Higher than normal blood glucose levels pose an increased risk of
developing severe health complications such as high blood pressure, heart disease,
vision loss, leg and feet amputation, kidney failure, nerve damage and it’s a
significant risk factor for developing glaucoma. Education and early detection are
major components to combating this disease. Several genetic and environmental
factors are involved with the onset of this chronic condition which is characterized
by hypoglycemia or dangerously low sugar levels. Prominent symptoms include
shakiness, confusion, disorientation and fainting. Medical billing and coding for
diabetes is a complex procedure, due to its associated manifestations.
Coding Guidelines for Diabetes
Here are the ICD-10-CM Official Coding and Reporting Guidelines for diabetes that
have been approved by four organizations namely - the American Hospital
Association (AHA), the American Health Information Management Association
(AHIMA), the Centers for Medicare & Medicaid Services (CMS), and the National
Center for Health Statistics (NCHS).
The coding guidelines for diabetes are mainly classified into four major sections -
 Section 1 –includes the structure and conventions of the classifications, the
general guidelines that apply to the classification along with chapter-specific
guidelines that correspond to the chapters as they are arranged in the
classification.

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 Section 2 - includes instructions for selection of principal diagnoses for non-
outpatient settings.
 Section 3 – includes guidelines for reporting additional diagnoses in non-
outpatient settings.
 Section 4 – includes guidelines for outpatient coding and reporting.
A careful review of all sections of the guidelines is important to fully understand the
rules and instructions required to code properly.
In ICD-10-CM, Chapter 4 - "Endocrine, nutritional and metabolic diseases (E00-
E89)," includes a separate subchapter (block), Diabetes mellitus, code range E08-
E13, with the categories -
 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
Further, the diabetes mellitus categories (E08–E13) are 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.
These chapter-specific diabetes guidelines contain six primary criteria -
 Type of diabetes
 Type of diabetes mellitus not documented
 Diabetes mellitus and the use of insulin and oral hypoglycemic
 Diabetes mellitus in pregnancy and gestational diabetes
 Complications due to insulin pump malfunction – this includes both under
dose and over dose of insulin due to insulin pump failure.
 Secondary diabetes mellitus –
 Secondary diabetes mellitus and the use of insulin or oral
hypoglycemic drugs

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 Assigning and sequencing secondary diabetes codes and causes -
Secondary diabetes mellitus due to drugs and/or due to
pancreatectomy
Coding for Diabetes – New Revisions for 2018
The additions/revisions for the coding of diabetes for the year 2018 includes –
Diabetes mellitus and the use of insulin and oral hypoglycemic drugs
If the documentation in a medical record does not indicate the type of diabetes, but
do indicate that the patient uses insulin, it is essential to assign the code E11- Type
2 diabetes mellitus. On the other hand, for patients with secondary diabetes
mellitus who routinely use insulin or oral hypoglycemic drugs- an additional code
should be assigned from category Z79 to identify the long-term (current) use of
insulin or oral hypoglycemic drugs. However, the code for long-term (current) use
of insulin should only be assigned if the patient is treated with both oral
medications and insulin. Code Z79.4 should not be assigned if insulin is given
temporarily to bring a secondary diabetic patient’s blood sugar under control during
an encounter.
Secondary diabetes mellitus – Codes that come under this category identify
complications or manifestations associated with secondary diabetes mellitus.
Secondary diabetes is always caused by another condition or event such as
malignant neoplasm of pancreas, adverse effect of drug/poisoning, cystic fibrosis
and pancreatectomy. Codes include -
 E08 - Diabetes mellitus due to underlying condition
 E09 - Drug or chemical induced diabetes mellitus
 E13 - Other specified diabetes mellitus

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Secondary diabetes mellitus and the use of insulin or oral hypoglycemic
drugs
For patients suffering from secondary diabetes mellitus who regularly use insulin or
oral hypoglycemic drugs – an additional code Z79 should be assigned. On the other
hand, if the patient uses both insulin and oral medications, only the code for long-
term (current) use of insulin should be assigned. In no case, code Z79.4 should be
assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under
control during an encounter.
Out of the 19 conventions found in Section 1 of the guidelines, the “with”
instruction (Convention No. 15) is related to diabetes. The convention explains –
 The word “with” or “in” should be interpreted to mean “associated with” or
“due to” when it appears in a code title, the Alphabetic Index, or an
instructional note in the Tabular List.
 These conditions should be directly coded as related (even in the absence of
a provider), unless and until the documentation clearly states that the
conditions are unrelated or when another guideline exists that specifically
requires a documented linkage between two conditions.
 In the alphabetic index, under the heading “diabetes”, the term “with” is
immediately listed. There are many terms/conditions that are listed as “with
diabetes.” It is for the medical coding professional to interpret the term
“with” to mean “associated with or due to”.
According to Centers for Disease Control and Prevention (CDC) (2017, national
statistics report) about 30.3 million people in the US have diabetes. With an
alarming increase in the number of diabetic patients, it is important to ensure that
physicians follow the correct coding and reporting guidelines. Coding for diabetes is
a complicated process particularly when the patient has multiple complications.
Experienced coders in reliable medical coding companies will utilize the
information from the physicians’ documentation to assign the appropriate codes,
and create claims for optimal reimbursement from insurance carriers.