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ICD-10 Guide
ICD-10 CodesO24.31

O24.31

Billable

Unspecified pre-existing diabetes mellitus in pregnancy

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

Code Description

ICD-10 O24.31 is a billable code used to indicate a diagnosis of unspecified pre-existing diabetes mellitus in pregnancy.

Key Diagnostic Point:

Unspecified pre-existing diabetes mellitus in pregnancy refers to a condition where a woman has diabetes prior to becoming pregnant, but the specific type of diabetes (Type 1 or Type 2) is not documented. This condition poses significant risks during pregnancy, including potential complications for both the mother and the fetus. Women with pre-existing diabetes may experience increased risks of hypertensive disorders, preterm labor, and cesarean delivery. Fetal complications can include macrosomia, congenital anomalies, and neonatal hypoglycemia. Management typically involves careful monitoring of blood glucose levels, dietary modifications, and possibly insulin therapy to maintain glycemic control. Regular fetal monitoring is essential to assess fetal growth and well-being, and to identify any potential complications early in the pregnancy. The healthcare team must collaborate closely to ensure optimal outcomes for both mother and child.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of diabetes type and management
  • Need for precise tracking of blood glucose levels and insulin usage
  • Potential for multiple comorbidities affecting pregnancy
  • Variations in treatment protocols among healthcare providers

Audit Risk Factors

  • Inadequate documentation of diabetes management and monitoring
  • Failure to specify the type of diabetes when known
  • Lack of evidence for fetal monitoring and assessments
  • Inconsistent coding of related complications

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include the type of diabetes, management strategies, and any complications encountered during pregnancy.

Common Clinical Scenarios

A pregnant woman with a known history of diabetes presenting for routine prenatal care, requiring adjustments in her insulin regimen.

Billing Considerations

Coders must ensure that all relevant clinical details are captured to support the diagnosis and management of diabetes in pregnancy.

Maternal-Fetal Medicine

Documentation Requirements

Detailed records of maternal-fetal assessments, including ultrasound findings and fetal monitoring results.

Common Clinical Scenarios

High-risk pregnancies involving women with pre-existing diabetes requiring specialized care and monitoring.

Billing Considerations

High-risk coding requires careful attention to detail and comprehensive documentation of all interventions and outcomes.

Coding Guidelines

Inclusion Criteria

Use O24.31 When
  • Coders should adhere to the official ICD
  • CM guidelines, ensuring that the code is used only when the type of diabetes is unspecified
  • Documentation must support the diagnosis and any related complications

Exclusion Criteria

Do NOT use O24.31 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 prenatal visits for patients with pre-existing diabetes.

Documentation Requirements

Document blood glucose levels, insulin adjustments, and any complications.

Specialty Considerations

Ensure that the visit reflects the complexity of managing diabetes in pregnancy.

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 requires distinguishing between the two based on the patient's history and clinical documentation.