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ICD-10 Guide
ICD-10 CodesO24.11

O24.11

Billable

Pre-existing type 2 diabetes mellitus, in pregnancy

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O24.11 is a billable code used to indicate a diagnosis of pre-existing type 2 diabetes mellitus, in pregnancy.

Key Diagnostic Point:

Pre-existing type 2 diabetes mellitus in pregnancy presents unique challenges for both maternal and fetal health. Women with this condition require careful management throughout their pregnancy to mitigate risks such as gestational hypertension, preeclampsia, and fetal macrosomia. Insulin management is crucial, as many women may need adjustments to their medication regimen to maintain optimal blood glucose levels. Regular fetal monitoring is essential to assess fetal growth and well-being, often involving ultrasound assessments and non-stress tests. The goal is to ensure a healthy pregnancy outcome while minimizing complications. Education on diet, exercise, and self-monitoring of blood glucose levels is also a key component of care. Coordination among obstetricians, endocrinologists, and dietitians is vital to provide comprehensive care for these patients.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for interdisciplinary management involving endocrinology and obstetrics.
  • Variability in insulin requirements throughout pregnancy.
  • Potential for multiple complications affecting coding.
  • Need for precise documentation of blood glucose levels and management plans.

Audit Risk Factors

  • Inadequate documentation of blood glucose monitoring.
  • Failure to document changes in insulin therapy.
  • Lack of detailed notes on fetal monitoring results.
  • Insufficient documentation of interdisciplinary consultations.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal health, including pre-existing conditions, treatment plans, and monitoring results.

Common Clinical Scenarios

Management of diabetes during routine prenatal visits, adjustments in insulin therapy, and monitoring for complications.

Billing Considerations

Accurate coding requires thorough documentation of both maternal and fetal assessments.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of high-risk assessments, including ultrasound findings and maternal-fetal interventions.

Common Clinical Scenarios

Management of high-risk pregnancies with pre-existing diabetes, including specialized monitoring and interventions.

Billing Considerations

Documentation must reflect the complexity of care and any complications that arise.

Coding Guidelines

Inclusion Criteria

Use O24.11 When
  • 10 coding guidelines specify that pre
  • existing conditions must be documented clearly, including the type of diabetes and any complications
  • Accurate coding requires adherence to guidelines for chronic conditions in pregnancy

Exclusion Criteria

Do NOT use O24.11 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 visits for diabetes management during pregnancy.

Documentation Requirements

Document blood glucose levels, medication adjustments, and patient education.

Specialty Considerations

Obstetricians should ensure comprehensive notes on 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 in pregnancy, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes in pregnancy, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Diabetes Association - Diabetes and Pregnancy

Coding & Billing References

  • •
    American Diabetes Association - Diabetes and Pregnancy

Frequently Asked Questions

What is the difference between pre-existing diabetes and gestational diabetes?

Pre-existing diabetes refers to diabetes diagnosed before pregnancy, while gestational diabetes develops during pregnancy. Accurate coding is essential to reflect the patient's condition.