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ICD-10 Guide
ICD-10 CodesE10.11

E10.11

Billable

Type 1 diabetes mellitus with ketoacidosis with coma

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E10.11 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with ketoacidosis with coma.

Key Diagnostic Point:

E10.11 refers to Type 1 diabetes mellitus characterized by the presence of ketoacidosis and coma. This condition arises when the body lacks sufficient insulin, leading to elevated blood glucose levels and the production of ketones, which can result in metabolic acidosis. Ketoacidosis is a serious complication of diabetes, particularly in Type 1 diabetes, where insulin deficiency is absolute. Symptoms may include excessive thirst, frequent urination, nausea, abdominal pain, and confusion. In severe cases, patients may progress to a state of coma due to the effects of acidosis on the brain. Management typically involves intravenous insulin therapy, fluid replacement, and electrolyte monitoring. The condition requires immediate medical attention to prevent life-threatening complications. Regular monitoring of HbA1c levels is crucial for managing diabetes and preventing such acute complications, with target levels generally below 7% for most adults. Insulin management is essential, as patients with Type 1 diabetes require exogenous insulin to maintain glycemic control.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of diabetes pathophysiology and complications.
  • Involves acute management scenarios that may vary by patient.
  • Documentation must clearly indicate the presence of ketoacidosis and coma.
  • Differentiation from other types of diabetes and related codes is necessary.

Audit Risk Factors

  • Inadequate documentation of ketoacidosis severity.
  • Failure to document the patient's coma state.
  • Lack of clear treatment protocols followed.
  • Inconsistent HbA1c levels reported in relation to acute events.

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed patient history, treatment plans, and lab results including HbA1c levels.

Common Clinical Scenarios

Management of acute diabetic ketoacidosis, insulin therapy adjustments.

Billing Considerations

Ensure clear documentation of the patient's diabetes type and acute complications.

Emergency Medicine

Documentation Requirements

Immediate assessment findings, treatment administered, and patient response.

Common Clinical Scenarios

Patients presenting with altered mental status due to diabetic ketoacidosis.

Billing Considerations

Document the timeline of events and interventions to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use E10.11 When
  • According to ICD
  • 10 coding guidelines, E10
  • 11 should be used when a patient with Type 1 diabetes presents with ketoacidosis and is in a state of coma
  • Documentation must support the diagnosis, including lab results and clinical findings

Exclusion Criteria

Do NOT use E10.11 When
  • Exclusion criteria include patients with Type 2 diabetes or those without ketoacidosis

Related ICD-10 Codes

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with severe diabetic ketoacidosis.

Documentation Requirements

Detailed documentation of the patient's condition and treatment provided.

Specialty Considerations

Emergency medicine specialists should ensure all acute interventions are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and reimbursement processes. E10.11 provides a clear distinction for Type 1 diabetes with ketoacidosis and coma, which is critical for appropriate management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes-related complications, improving the accuracy of patient records and reimbursement processes. E10.11 provides a clear distinction for Type 1 diabetes with ketoacidosis and coma, which is critical for appropriate management and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. E10.11 provides a clear distinction for Type 1 diabetes with ketoacidosis and coma, which is critical for appropriate management and resource allocation.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What is the significance of coding E10.11?

Coding E10.11 is crucial for accurately representing a patient's condition of Type 1 diabetes with ketoacidosis and coma, which requires immediate medical intervention and has significant implications for treatment and billing.