Wiki Uncontrolled Diabetes in ICD10-Coding Clinic

[jmmurray120@gmail.com]

Hello All. Having this discussion with a coding vendor and there is some confusion. When ICD-10 came out a big change was that Uncontrolled Diabetes was coded as E1165 Diabetes with hyperglycemia rather than E119. This Coding Clinic determination was pointed out to me and I'm having a hard time interpreting. Does this mean we are not to code as E1165 unless the provider says with hyper or hypo glycemia?

AHA Coding Clinic (Vol.4, No.1, 1st Quarter, 2017)
There is no default code for “uncontrolled diabetes.” Effective October 1, 2016, uncontrolled diabetes is classified by type and whether it is hyperglycemia or hypoglycemia. If the documentation is not clear, query the provider for clarification whether the patient has hyperglycemia or hypoglycemia so that the appropriate code may be reported; uncontrolled diabetes indicates that the patient’s blood sugar is not at an acceptable level, because it is either too high or too low. In the ICD-10-CM Index to Diseases, uncontrolled diabetes can be referenced as follows:
Diabetes, diabetic (mellitus) (sugar) E11.9
uncontrolled
meaning
hyperglycemia – see Diabetes, by type, with hyperglycemia
hypoglycemia – see Diabetes, by type, with hypoglycemia

 

[almorris78]

If the provider states that the diabetes is type II uncontrolled, it would be a query back to have them clarify if they are diagnosing hyperglycemia or hypoglycemia. It is also required to code the add on code for insulin or oral diabetic medication per the 2017 coding guidelines. The terms "controlled" and "uncontrolled" are not specific enough in ICD-10, so verbiage such as "without complication" or "with complication" specifying the complication is the correct way for the provider to document.