Other disorders of glucose regulation and pancreatic internal secretion
ICD-10 Codes (8)
E16E16.0E16.1E16.2E16.3E16.4E16.8E16.9Updates & Changes
FY 2026 Updates
Deleted Codes
No codes deleted in this range for FY 2026
No significant changes for FY 2026
This range maintains stability with current coding practices
Historical Changes
- •FY 2025: Routine maintenance updates with minor terminology clarifications
- •FY 2024: Enhanced specificity requirements for certain code ranges
- •FY 2023: Updated documentation guidelines for improved clarity
Upcoming Changes
- •Proposed updates pending review by Coordination and Maintenance Committee
- •Under consideration: Enhanced digital health integration codes
Implementation Guidance
- •Review all FY 2026 updates for E15-E16 codes before implementation
- •Always verify the most current codes in the ICD-10-CM manual
- •Ensure clinical documentation supports the selected diagnosis codes
- +3 more guidance items...
Range Overview
The E08-E13 range in ICD-10 is dedicated to Diabetes Mellitus, a chronic disease characterized by high blood sugar levels. This range covers all types of diabetes, including Type 1, Type 2, gestational, and drug-induced diabetes. It also includes codes for various complications and manifestations associated with diabetes, such as diabetic retinopathy, nephropathy, and neuropathy. The codes in this range are crucial for accurately documenting the patient's condition and ensuring appropriate reimbursement for services provided.
Key Usage Points:
- •Always specify the type of diabetes (Type 1, Type 2, gestational, etc.) in the documentation.
- •Include details about any complications or manifestations associated with the diabetes.
- •Distinguish between controlled and uncontrolled diabetes in the documentation.
- •Use combination codes to capture diabetes with associated complications in a single code.
- •Always code to the highest level of specificity.
Coding Guidelines
When to Use:
- ✓When a patient is diagnosed with any type of diabetes.
- ✓When a patient with diabetes presents with associated complications or manifestations.
- ✓When a patient's diabetes status changes from controlled to uncontrolled, or vice versa.
- ✓When a patient with diabetes is pregnant (gestational diabetes).
- ✓When a patient's diabetes is induced by drugs or chemicals.
When NOT to Use:
- ✗When a patient has prediabetes or impaired glucose tolerance, use codes from the R73 range instead.
- ✗When a patient has neonatal diabetes mellitus, use code P70.2.
- ✗When a patient has secondary diabetes mellitus, use codes from the E08 range.
- ✗When a patient has diabetes insipidus, use code E23.2.
- ✗When a patient has diabetes due to cystic fibrosis, use code E84.11.
Code Exclusions
Always verify exclusions by cross-referencing the patient's clinical documentation and the ICD-10 coding manual.
Documentation Requirements
Proper documentation for diabetes coding should include the type of diabetes, the control status (controlled or uncontrolled), and any associated complications or manifestations. The documentation should be detailed and specific, providing a clear picture of the patient's condition.
Clinical Information:
- •Type of diabetes
- •Control status of diabetes
- •Presence of any complications
- •Specific type of complication, if applicable
- •Any other relevant clinical information
Supporting Evidence:
- •Lab results confirming the diagnosis
- •Clinical notes detailing the patient's symptoms and treatment
- •Imaging studies, if applicable
- •Referral letters or specialist reports
Good Documentation Example:
Patient has Type 2 diabetes, well-controlled, with moderate diabetic retinopathy.
Poor Documentation Example:
Patient has diabetes.
Common Documentation Errors:
- ⚠Not specifying the type of diabetes
- ⚠Failing to document the control status of the diabetes
- ⚠Not including details about complications
- ⚠Using non-specific language
Range Statistics
Coding Complexity
The complexity of coding for diabetes lies in the need to accurately capture the type of diabetes, control status, and any associated complications. This requires a thorough understanding of the disease and its manifestations, as well as a strong grasp of ICD-10 coding guidelines. Additionally, coding for diabetes is subject to frequent updates and changes, adding to the complexity.
Key Factors:
- ▸Determining the type of diabetes
- ▸Identifying and coding for associated complications
- ▸Distinguishing between controlled and uncontrolled diabetes
- ▸Understanding and applying combination codes
- ▸Keeping up to date with changes to coding guidelines
Specialty Focus
The E08-E13 range is particularly relevant to endocrinologists, primary care physicians, and ophthalmologists. These specialists often manage patients with diabetes and its complications.
Primary Specialties:
Clinical Scenarios:
- • A patient with Type 1 diabetes presents with diabetic nephropathy.
- • A patient with Type 2 diabetes has poorly controlled blood sugar levels.
- • A pregnant patient is diagnosed with gestational diabetes.
- • A patient with diabetes presents with peripheral neuropathy.
- • A patient's diabetes is induced by steroid medication.
Resources & References
Several resources are available to assist with coding for diabetes. These include the official ICD-10 coding manual, clinical reference books, and educational materials from professional coding organizations.
Official Guidelines:
- ICD-10-CM Official Guidelines for Coding and Reporting
- American Health Information Management Association (AHIMA) Coding Clinic
- Centers for Medicare & Medicaid Services (CMS) ICD-10 Provider Resources
Clinical References:
- American Diabetes Association Standards of Medical Care in Diabetes
- Endocrine Society Clinical Practice Guidelines
Educational Materials:
- AHIMA ICD-10 Training Modules
- American Academy of Professional Coders (AAPC) ICD-10 Resources
Frequently Asked Questions
How do I code for a patient with Type 2 diabetes and diabetic retinopathy?
Use a combination code from the E11.3 subcategory to capture both the Type 2 diabetes and the diabetic retinopathy. The fourth character specifies the type of retinopathy.
What is the difference between controlled and uncontrolled diabetes in terms of coding?
ICD-10 does not differentiate between controlled and uncontrolled diabetes. Instead, it uses terms like 'with' and 'without' to indicate the presence or absence of complications. However, the control status of diabetes can still be documented for clinical purposes.