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Diabetes, type 2, uncontrolled for I-10 - coding Diabetes

  1. Default
    Medical Coding Books
    The 2016 AHA Coding Handbook gives this example in a practice question:
    Question: uncontrolled type 2 diabetes mellitus
    Answer: E33.65 DM2 w/hyperglycemia

  2. Default
    that should read: E11.65

  3. Post Uncontrolled Diabetes AHA Coding Clinic 2017
    How is uncontrolled diabetes mellitus (DM) coded in ICD-10-CM? Is uncontrolled the same as "poorly controlled" or "out of control? Currently, only "out of control" and "poorly controlled" diabetes mellitus are coded as diabetes with hyperglycemia.
    Answer:
    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)
    Uncontrolled meaning
    hyperglycemia - see Diabetes, by type, with hyperglycemia
    hypoglycemia - see Diabetes, by type, with hypoglycemia

  4. #14
    Default
    Quote Originally Posted by mitchellde View Post
    The problem I have with articles like this is that this is someone's version or opinion and they wrote an article. At no time is an official source cited for that statement. I agree that diabetes with hyperglycemia is an out of control disease process, however I do not agree that just because the provider documents "uncontrolled", that this is always what they are referencing. In other words a diabetic patient that does not always adhere to proper diet or does not take the insulin correctly, while they may not yet be hyperglycemic, the provider may document the diabetes is poorly controlled. The coding guidelines do not direct us to code uncontrolled status as diabetes with hyperglycemia. And the classification does not have a listing for diabetes, uncontrolled, or uncontrolled, diabetes. Without an official source, I will default to , if the provider does not state diabetes with hyperglycemia, then it cannot be coded that way.
    Another point to consider on this, an endocrinologist once told me that the reason the ICD-9 classification choices state, uncontrolled, or not stated as uncontrolled instead of uncontrolled vs controlled, is that diabetes is truly never in a "controlled" state and the reason this is not stated this way in ICD-10 CM is because the physician does not need to document this, it is understood that the reason we monitor the diabetic patient as closely as we do is because they are never truly under control. He had a lot more to say on this subject and it does make sense.
    So I would hesitate to put stock in an article that makes a bold statement but does not back it up.

    I 100% agree with Mitchellde.

    If you look in the index under Diabetes Mellitus Type II, under "Uncontrolled" it states "meaning" and under that it says "Hyperglycemia - see Diabetes, by type, with Hyperglycemia. Same thing goes for Hypoglycemia. the index will lead you to either E11.65, or E11.649. "Uncontrolled" by itself is meaningless in ICD-10-CM. The doctor MUST specify DM Type II WITH Hypoglycemia or Hyperglycemia. Otherwise you down-code it to E11.9.
    Last edited by chaimz; 04-06-2017 at 12:59 PM.

  5. Default Diabetes, uncontrolled, out of control, poorly controlled, inadequately controlled
    Quote Originally Posted by mitchellde View Post
    The problem I have with articles like this is that this is someone's version or opinion and they wrote an article. At no time is an official source cited for that statement. I agree that diabetes with hyperglycemia is an out of control disease process, however I do not agree that just because the provider documents "uncontrolled", that this is always what they are referencing. In other words a diabetic patient that does not always adhere to proper diet or does not take the insulin correctly, while they may not yet be hyperglycemic, the provider may document the diabetes is poorly controlled. The coding guidelines do not direct us to code uncontrolled status as diabetes with hyperglycemia. And the classification does not have a listing for diabetes, uncontrolled, or uncontrolled, diabetes. Without an official source, I will default to , if the provider does not state diabetes with hyperglycemia, then it cannot be coded that way.
    Another point to consider on this, an endocrinologist once told me that the reason the ICD-9 classification choices state, uncontrolled, or not stated as uncontrolled instead of uncontrolled vs controlled, is that diabetes is truly never in a "controlled" state and the reason this is not stated this way in ICD-10 CM is because the physician does not need to document this, it is understood that the reason we monitor the diabetic patient as closely as we do is because they are never truly under control. He had a lot more to say on this subject and it does make sense.
    So I would hesitate to put stock in an article that makes a bold statement but does not back it up.


    Folks, the author of this article is precisely correct in their statement that "Instead ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia" (i.e. should be coded as Diabetes with hyperglycemia [type I or II if specified]. The oversight that many coders are making leading to misunderstanding is that they are jumping straight to the sub-term "uncontrolled" (which is synonymous now with out of control, poorly controlled and inadequately controlled) and getting confused by the vague breakdown of Diabetes with hyperglycemia vs. the separately listed sub-term for hypoglycemia. Because of that coders appear to be overlooking the most specific indexing instructions appearing under the main term "Diabetes, diabetic" itself.

    Look beneath that main term (meaning, prior to the sub-terms for Type I and II) and you will note that the sub-terms and coding instructions for the following various control descriptions are clearly stated: "inadequately controlled - code to Diabetes, by type, with hyperglycemia"; "out of control - code to Diabetes, by type, with hyperglycemia"; and "poorly controlled - code to Diabetes, by type, with hyperglycemia".

    Therefore, AHIMA's Journal article instructions are indeed correct that (notwithstanding a physician clearly stipulating hypoglycemia as the issue), the correct code for the above uncontrolled/out of control/poorly controlled/inadequately controlled statuses is Diabetes with hyperglycemia (with Type if known).

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