Coding Diabetes Mellitus in
IMPROVED CODING FOR DIABETES MELLITUS COMPLEMENTS
PRESENT MEDICAL SCIENCE
By Karen M. Kostick, RHIT, CCS, CCS-P
RESULTS OF A recent coding and clinical documentation pilot study indicate that the ICD-10-CM coding classification chang- es made for diabetes mellitus have significantly improved cod- ing for this disease. The results of the study noted that although a few ICD-10-CM “unspecified” diabetes codes were assigned, the majority of the diabetes codes sufficiently captured the di- agnoses as expressed in the clinical documentation. In addition, the pilot study noted that the ICD-10-CM diabe- tes codes complement present medical science—separate type 1 and type 2 diabetes category codes and body system combina- tion codes are a major improvement over ICD-9-CM. Instead of classifying as controlled or uncontrolled, ICD-10-CM classifies
inadequately controlled, out of control, and poorly controlled
diabetes mellitus by type with hyperglycemia. This article highlights key ICD-10-CM features for diabetes mellitus coding.
In ICD-10-CM, chapter 4, “Endocrine, nutritional and meta-
bolic diseases (E00-E89),” includes a separate subchapter
(block), Diabetes mellitus E08-E13, with the categories:
The diabetes mellitus categories E08–E13 are further subdi-
vided into four- or five-character subcategories. When a catego-
ry has been subdivided into four-, five-, or six-character codes,
the diabetes code assigned represents the highest level of speci-
ficity within ICD-10-CM.
ICD-10-CM Tabular Instructional Notes
Diabetes mellitus tabular inclusions notes are introduced by
the term “Includes” and appear at the beginning of a category.
Categories E10–E13 inclusion notes further define or provide
examples of the content within each category, as illustrated in
The “Excludes1” note meaning “not coded here” appears under all the diabetes mellitus categories. An Excludes1 note indicates that the code excluded should never be used at the same
time as the code above the Excludes1 note.
Similar to ICD-9-CM, “Code first” and “Use additional code”
notes are present for some of the diabetes mellitus categories
and subcategories that require the underlying condition be sequenced first, followed by the manifestation. The Use additional
code note appears at the etiology code and a Code first note at
the manifestation code.
ICD-10-CM diabetes codes are combination codes that include the type of diabetes mellitus, body system affected, and
the complications affecting that body system. The following
examples apply ICD-10-CM chapter 4, “Diabetes mellitus E08-
E13,” tabular list instructions and illustrate diabetes mellitus
code combinations and code specificity.
First, suppose a patient is seen for diabetic chronic kidney disease, stage 3. The patient has type 2 diabetes and takes insulin
on a daily basis. The appropriate code assignments would be:
x E11.22, Type 2 diabetes mellitus with diabetic chronic
x N18.3, Chronic kidney disease, stage 3 (moderate)
x Z79.4, Long term (current) use of insulin