Partnership Guide 2023Diabetes Mellitus (DM)

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Documentation and codingControl StatusControl status is not required for code assignment; there is no default code for uncontrolled diabetes. When uncontrolled diabetes is reported, the assessment must state hypoglycemia or hyperglycemia to assign a code other than diabetes without complications, and must include clinical documentation supporting the diagnosis.

Use one of the five categories to identify the clinical manifestation:

E08 - DM - due to underlying condition
E09 - Drug- or chemical-induced DM
E10 - Type 1 DM
E11 - Type 2 DM
E13 - Other specified DM

Use a third character to denote the type of DM (e.g., Type 1 or Type 2)

Use a fourth character to denote the type of DM complication

Use a fifth and sixth character to denote the subclassification of the body system complication

In most cases, a single combination code reports both the DM and the complication

Follow additional code instructions for CKD stage, glaucoma and ulcer site complication

Current or long-term use of insulin should be coded as Z79.4

Complications and Manifestations

All DM manifestations should be documented with specific details of complications. Use the term “with” in conjunction with DM and a manifestation; other phrases, such as due to, secondary to, or diabetic, may also establish a cause-and-effect relationship between the diabetes and the associated complication.

In most cases, ICD-10-CM provides a single code to report both the DM and complications. These are combination codes that report the type of DM, the affected body system, and the specific complications affecting the system. Use additional codes when directed, i.e., code for CKD stages. Complications include, but are not limited to these types, circulatory, kidney, ophthalmic, neurological, arthropathies, skin/dermatologic, etc. Report each associated complication, including an assessment and treatment plan.

All DM manifestations should be documented. If multiple comorbid manifestations exist for the same patient the documentation should be inclusive (i.e., DM with CKD treated with medication. Also document the CKD stage with status and plan.)

If unsure of the diagnosis, then the condition should be coded to the highest level of certainty

Pre-diabetes, abnormally high glucose levels that do not meet criteria for a diabetes diagnosis, should not be considered a clinical condition for which diabetic complications are reported.

img1TipTo help ensure you are documenting to the highest degree of specificity for appropriate ICD-10 code assignment, go to MedicareProviders.Cigna.com > Provider Education.img2img3img4Coding ExamplesExample 1*Pt is a 62 y/o BF with PMH of DM with CKD and Hyperlipidemia. She presents today for follow up care of chronic conditions. Most FBS readings have been between 120 and 150. She has no other complaints or health concerns today.Social Hx- divorced, denies tobacco use, moderate alcoholBP 138/88 Pulse 84 Resp. 16 Ht. 5-5” Wt. 165 BMI: 27.45Med List- Lantus 20 U SQ qd; Lisinopril 20 mg 1 po qd; Atorvastatin 40 mg 1 po qd; ASA 81 mg 1 po qdLabs- HgbA1c 8.0, Creatinine 1.8, eGFR 40 (5 days prior to visit)Plan – Continue current medications and monitoring plan for DM. Follow up with Dr. Smith/Nephrology for CKD stage 3b.Coded as:E11.22 – Diabetes 2 with diabetic chronic kidney diseaseN18.32 – Chronic kidney disease stage 3bZ79.4 - Long term use of insulinExample 2* Pt is a 71 y/o WF with PMH of DM with CKD and diabetic neuralgia. She presents today for follow up care of chronic conditions. Most FBS readings have been between 120 and 150.Social Hx- widowed, alcohol - 2 drinks/day, denies tobacco usePulse 84 Resp. 16 Ht. 5-4” Wt. 200 BMI: 34.3Med List- Lantus 30 U SQ qd; Metformin 500mg tid/ac; Atorvastatin 40 mg 1 po qdLabs- HgbA1c 8.0, Creatinine 1.8, eGFR 46 (1 week prior to visit)Plan:DM type 2 - continue meds, Refill 10 mL Lantus, 30 U SQ qdCKD stage 3a – follow with nephrology/repeat eGFRPeripheral neuropathy – schedule nerve conduction study with neurologyObesity – discontinue alcohol, follow diet plan providedCoded as:E11.22 - Diabetes mellitus type 2 with diabetic chronic kidney diseaseN18.31 – Chronic kidney disease stage 3a E11.42 - Diabetes mellitus type 2 with diabetic polyneuropathyE66.9 – ObeseZ68.34 – BMI 34.3*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient.Content updated April 20232023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health