Call on Combination Codes for Diabetes

Call on Combination Codes for Diabetes

Understand concepts that may or may not factor into ICD-10-CM code choices.

by Peggy Stilley, CPC, CPB, CPMA, COBGC

A major change when transitioning from ICD-9-CM to ICD-10-CM is the use of combination codes. In some cases, combination codes allow fewer codes to fully describe the patient’s conditions. Other combination codes require a secondary code to further describe the complication or the severity of the condition.

For example, diabetes mellitus is described using combination codes that include:

  • Type of diabetes
  • Body system affected
  • Complication affecting the body system

Diabetes includes five categories of ICD-10-CM codes:

E08 Diabetes mellitus due to underlying condition

E09 Drug or chemical induced diabetes mellitus

E10 Type I diabetes mellitus

E11 Type II diabetes mellitus

E13 Other specified diabetes mellitus (secondary, due to genetic defects, postprocedural)

Each type of diabetes provides a code for the complication or body system affected by the diabetes. ICD-10-CM coding guidelines in chapter 4 – Endocrine, Nutritional, and Metabolic Diseases – E00-E89 state that if the type of diabetes mellitus is not provided in documentation, the default is E11.-, type II diabetes.

Rethink Factoring Components

In ICD-10-CM coding, diabetes controlled or uncontrolled is not a concept; although, clinical documentation should provide the status of the patient’s condition and the response to treatment.

The concept of insulin dependent and non-insulin dependent is not a component in ICD-10-CM coding, either. You are instructed to report the long-term, current use of insulin for diabetic management in all categories of diabetes, with the exception of type I (E10).

You may report more than one diabetes code for patients with multiple complications or when multiple body systems are affected as a result of diabetes. This shows a more accurate view of the patient being treated, and could assist in supporting medical necessity, while showing complexity of medical decision-making.

Case No. 1

Patient presents with type I diabetes with no complications. Her sugars are well controlled with Lantus®, exercise, and diet. She will continue with same medication dosage, monitor glucose levels, and return in three months for recheck.

ICD-10-CM coding:

E10.9 Type I diabetes mellitus without complications

In this case, the patient has no complications, with normal sugars reported. The use of insulin is not reported with type I diabetes mellitus.

Case No. 2 

A 56-year-old, obese male with a long history of adult onset diabetes mellitus is seen for a follow-up evaluation. He has no new symptoms. He has been dependent on insulin for 10 years, and has stage 2 diabetic chronic kidney disease (CKD). He does not keep his calories or diet in range.

Vitals: Weight: 245. Height: 5’10”. Blood glucose: 125. Exam otherwise unremarkable.

Calculated BMI: 35.1

Assessment: Type 2 diabetes mellitus with CKD stage 2, obesity

ICD-10-CM coding:

E11.22 Type II diabetes mellitus with diabetic chronic kidney disease

N18.2 Chronic kidney disease, stage 2 (mild)

E66.09 Other obesity due to excess calories

Z68.35 Body mass index (BMI) 35.0-35.9, adult

Z79.4 Long term (current) use of insulin

In this case, documentation shows a type 2 diabetic with associated CKD, stage 2. A combination code for the type of diabetes and the complication of CKD requires two codes. The BMI is reported secondary to obesity due to excess calories. The final code identifies current use of insulin as the diabetes control method.


 

Peggy Stilley, CPC, CPB, CPMA, COBGC, is AAPC director of ICD-10 development and training.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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About Has 428 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

2 Responses to “Call on Combination Codes for Diabetes”

  1. SSF says:

    If the provider documents “patient was given advise on dietary measures eat three meals with healthy snakes in between meals and to walk 30 minutes a daily. Would you code Z71.3 dietary counseling and surveillance?

  2. SSF says:

    No need to respond, also corrections “Snacks” not snakes. Thank you

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