Coding for Diabetes in Pregnancy using ICD-10-CM
Diabetes mellitus is a condition characterized by high blood sugars, either because the person does not produce enough insulin, or because the cells do not respond to the insulin that is produced. There are three main types of diabetes mellitus (DM). Type I DM occurs when the body fails to produce enough insulin, and as a result, the person is required to take insulin. This form was previously referred to as “insulin-dependent diabetes mellitus” (IDDM) or “juvenile diabetes”. Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly. Type 2 was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or “adult-onset diabetes”. The third type is gestational diabetes and occurs when pregnant women without a previous diagnosis of diabetes develop high blood glucose levels.
Currently, using ICD-9-CM, if a diabetic patient becomes pregnant, a code from 648.0x Diabetes mellitus complicating pregnancy and a secondary code from category 250 Diabetes mellitus or category 249 Secondary diabetes should be assigned to identify the type of diabetes. If the diabetes is being treated with insulin, then code V58.67 Long-term (current) use of insulin should also be assigned.
If a patient develops gestational diabetes during their pregnancy, according to ICD-9-CM, a code from 648.8x Abnormal glucose tolerance is applied. Again, if insulin is used to treat gestational diabetes, code V58.67 Long-term (current) use of insulin is assigned.
There are similarities to coding in ICD-10-CM, but there is a significant difference when coding for gestational diabetes.
Using ICD-10-CM, women who are diabetic and become pregnant should be assigned a code from category O24 Diabetes mellitus in pregnancy, childbirth, and the puerperium first, followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4. This is similar to how codes are assigned currently using ICD-9-CM. There is also a code for long-term use of insulin in ICD-10-CM, Z79.4 Long-term (current) use of insulin and it should be assigned if the diabetes mellitus is being treated with insulin.
Codes for gestational diabetes are found in subcategory O24.4 Gestational diabetes mellitus. The codes under subcategory O24.4 include diet controlled and insulin controlled. 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.
There is a difference between gestational diabetes and abnormal glucose tolerance in pregnancy. Careful documentation will ensure accurate coding. Abnormal glucose is assigned a code from subcategory O99.81 Abnormal glucose complicating pregnancy, childbirth, and the puerperium in ICD-10-CM.
Diabetes can complicate a pregnancy but it doesn’t need to cause complications for coding, if you follow the guidelines.