Wiki E11.A Type 2 diabetes in remission and ordering A1c lab tests

[SSweetland]

In discussion with providers today about the new ICD-10 code E11.A Diabetes in Remission brought up a question. Ordering A1c lab test still needs to be monitored but if the patient is in "remission" and E11.9 is an exclude then what diagnosis will meet medical necessity and will there be a frequency. From what I am reading a lab might still be done every 3 to 6 months but there was no guidance on the diagnosis. I tried to look up payer policy and was not able to find an answer. thank you in advance.

 

[keke74]

The new ICD-10 code E11.A Diabetes in remission should still meet the criteria for medical necessity. Diabetes in remission does not mean the condition is cured. The ongoing monitoring is still essential for managing the potential risk of relapse. It's also going to be important as with every diagnosis for providers documentation to support and/or justify the diagnosis to help with medical necessity.