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ICD-10 Guide
ICD-10 CodesE10.5

E10.5

Billable

Type 1 diabetes mellitus with circulatory complications

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

Code Description

ICD-10 E10.5 is a billable code used to indicate a diagnosis of type 1 diabetes mellitus with circulatory complications.

Key Diagnostic Point:

Type 1 diabetes mellitus is a chronic condition characterized by the autoimmune destruction of insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency. Patients with Type 1 diabetes are at increased risk for various complications, particularly circulatory complications, which can include peripheral vascular disease, ischemic heart disease, and cerebrovascular disease. These complications arise due to chronic hyperglycemia, which can damage blood vessels and nerves over time. The management of Type 1 diabetes typically involves insulin therapy, with the goal of maintaining blood glucose levels within a target range, often reflected by HbA1c levels. An HbA1c level of 7% or lower is generally recommended for most adults, but individual targets may vary based on patient-specific factors. Regular monitoring and management of blood glucose levels, along with lifestyle modifications, are crucial in preventing or delaying the onset of circulatory complications. The presence of these complications necessitates careful coding to ensure accurate representation of the patient's condition and appropriate reimbursement for the healthcare services provided.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple potential circulatory complications to document
  • Need for precise HbA1c level reporting
  • Insulin management variations among patients
  • Differentiation from other types of diabetes

Audit Risk Factors

  • Inadequate documentation of circulatory complications
  • Failure to report HbA1c levels accurately
  • Misclassification of diabetes type
  • Lack of evidence for insulin management strategies

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed records of insulin therapy, HbA1c levels, and any complications.

Common Clinical Scenarios

Management of Type 1 diabetes with associated cardiovascular issues.

Billing Considerations

Ensure documentation reflects the severity and management of circulatory complications.

Cardiology

Documentation Requirements

Comprehensive assessment of cardiovascular health in diabetic patients.

Common Clinical Scenarios

Evaluation and treatment of ischemic heart disease in patients with Type 1 diabetes.

Billing Considerations

Document the relationship between diabetes management and cardiovascular outcomes.

Coding Guidelines

Inclusion Criteria

Use E10.5 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the patient's diabetes type and any associated circulatory complications
  • Include specific details about the patient's management plan and HbA1c levels

Exclusion Criteria

Do NOT use E10.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for routine follow-up of a patient with Type 1 diabetes and circulatory complications.

Documentation Requirements

Document the patient's diabetes management, HbA1c levels, and any complications.

Specialty Considerations

Endocrinologists should ensure comprehensive documentation of diabetes management.

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. E10.5 provides a clear indication of the presence of circulatory complications, which is essential for appropriate management and care planning.

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. E10.5 provides a clear indication of the presence of circulatory complications, which is essential for appropriate management and care planning.

Reimbursement & Billing Impact

reimbursement processes. E10.5 provides a clear indication of the presence of circulatory complications, which is essential for appropriate management and care planning.

Resources

Clinical References

  • •
    American Diabetes Association

Coding & Billing References

  • •
    American Diabetes Association

Frequently Asked Questions

What are the key factors to document for E10.5?

Key factors include the type of diabetes, specific circulatory complications, HbA1c levels, and the patient's insulin management plan.