DIABETES MELLITUS (DM)

Provider’s guide to diagnose and code Diabetes Mellitus

Background Diagnosing
According to a (2014) report by the Centers ADM as controlled or uncontrolled is based on:
for Disease Control (CDC): › Symptoms
› Approximately 29 million Americans › Related diseases
have type II diabetes › Glycated hemoglobin (HgA1c)
• Over 11 million people aged 65 and
› Provider’s clinical judgment
older have the diagnosis1 Though there are varying definitions of “controlled,”
The American Diabetes Association (2014)
› Approximately 200,000 people have type I diabetes recommends that the HgA1c target should be:
› Nearly 14% of American health care dollars › ≤ 7% percent in most cases

are spent on DM related care › ≤ 8% in certain cases when there is:

• A history of severe hypoglycemia

• Limited life expectancy
• An elderly patient2
ICD-10 code documentation:
Uncontrolled DM is diagnosed when the current
› “Controlled/Uncontrolled” classification has been
treatment regimen does not keep the blood
eliminated for ICD-10, therefore inadequately,
sugar level within acceptable levels.
out of control, or poorly controlled are

coded by DM type with hyperglycemia

Note: If unsure of the diagnosis, then the condition
› Uses 5 categories to identify the clinical manifestation should be coded to the highest degree of certainty
• E08: DM
• E09: Drug or chemical induced DM Important tips
• E10: Type 1 DM 1. Be legible, clear and concise
• E11: Type 2 DM
2. Avoid acronyms
• E13: Other specified DM
3. Ensure document is signed and dated
› Uses a 3rd character to denote the type of DM

by a credentialed provider
› Uses a 4th character to denote the

4. Each diagnosis must have an assessment

type of DM complication

and a treatment plan and follow-up

› Uses a 5th and 6th character to denote the sub

5. Verify patient demographics, such

classification of the body system complication

as name and date of birth

› Uses a single code to identify type

of DM and the complication

6. Make sure there is a date of service
with the clinical encounter
› In most cases a single code reports both

the DM and the complication

7. Complications need to be documented with an appropriate
treatment plan. See the Tips & Linking table for assistance.
› Additional codes required for CKD stage,

glaucoma, and ulcer site complication

› Uses a (-) dash instead of (x), this indicates the code

requires further characters to account for specificity
› Rejects non-specific codes
› Requires that insulin be coded as Z79.4
› Documents DM complications
› Illustrates the cause and effect relationship

with conclusive linking words

• Example: Renal failure secondary to diabetes

Use conclusive Avoid inconclusive

linking words linking words

Due to Probably
Caused by Suspected
Secondary to Likely

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2015 ICD-10-CM 2015 ICD-10-CM
ICD-10­ Description Definition / Tips ICD-10­ Description Definition / Tips
CM Code CM Code

E10.9 Type 1 DM w/o E10.5­ Type 1 DM (-) Add 5th character:

complications w/circulatory 1 – diabetic peripheral angiopathy w/o gangrene
E11.9 Type 2 DM w/o complication
2 – diabetic peripheral angiopathy w/gangrene
complications E11.5­ Type 2 DM 9 – w/other circulatory complications
E10.2­ Type 1 DM (-) Add 5th character: w/circulatory
w/kidney 1 – diabetic nephropathy complication
complication 2 – diabetic CKD Use additional
*Use additional code to identify code to identify
E11.2­ Type 2 DM stage of CKD (N18.1-N18.6) insulin use (Z79.4)
w/kidney 9 – other diabetic kidney complication
complication E10.6­ (-)Add 5th and 6th characters:
Use additional 10 – diabetic neuropathic arthropathy
code to identify E11.6­ 18 – other diabetic arthropathy
insulin use (Z79.4) 20 – diabetic dermatitis
E10.3­ Type 1 DM (-) Add 5 and 6 characters:
th th 21 – w/foot ulcer
w/ophthalmic 11 – unspecified diabetic retinopathy Use additional code for
complication w/macular edema ulcer site (L97.4, L97.5)
E11.3­ Type 2 DM 19 – unspecified diabetic retinopathy 22 – w/other skin ulcers
w/o macular edema
w/ophthalmic Use additional code for
complication 21 – mild non-proliferative diabetic
ulcer site (L97.-, L98.-)
retinopathy w/macular edema
Use additional 28 – w/other skin complications
code to identify 29 – mild non-proliferative diabetic
insulin use (Z79.4) retinopathy w/o macular edema 30 – w/periodontal disease
31 – moderate non-proliferative diabetic 38 – w/other oral complications
retinopathy w/macular edema 41 – w/hypoglycemia w/coma
39 – moderate non-proliferative diabetic
49 – w/hypoglycemia w/o coma
retinopathy w/o macular edema
41 – severe non-proliferative diabetic 5 – w/hyperglycemia
retinopathy w/macular edema 9 – w/other specified complication
49 – severe non-proliferative diabetic Use additional code to identify complication
retinopathy w/o macular edema
E10.8 Type 1 DM w/unspecified complication
51 – proliferative diabetic
retinopathy w/macular edema
59 – proliferative diabetic retinopathy E11.8 Type 2 DM w/unspecified complication
w/o macular edema Use additional code to identify insulin use (Z79.4
6 – w/diabetic cataract
9 – w/other diabetic ophthalmic complications
Use additional code to identify References:
glaucoma (H40-H42) 1. Centers for Disease Control. (2014). National Diabetes Statistic Report. DOI: http://www.cdc.gov/diabetes/
pubs/statsreport14/national-diabetes-report-web.pdf
E10.4­ Type 1 DM (-) Add 5th character:
w/neurological 0 – diabetic neuropathy, unspecified 2. American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care, 37, Suppl
complication 1:S14.
1 – diabetic mononeuropathy
E11.4­ Type 2 DM 2 – diabetic polyneuropathy
w/neurological 3 – diabetic autonomic (poly)neuropathy
complication (gastroparesis)
Use additional 4 – diabetic amyotrophy
code to identify 9 – other diabetic neurological complication
insulin use (Z79.4)