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ICD-10 Guide
ICD-10 CodesO24.319

O24.319

Billable

Unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester

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

Code Description

ICD-10 O24.319 is a billable code used to indicate a diagnosis of unspecified pre-existing diabetes mellitus in pregnancy, unspecified trimester.

Key Diagnostic Point:

Unspecified pre-existing diabetes mellitus in pregnancy refers to cases where a woman has diabetes that existed prior to pregnancy but does not specify the type of diabetes (Type 1 or Type 2) or the trimester of pregnancy. This condition poses significant risks to both the mother and fetus, including potential complications such as preeclampsia, macrosomia, and neonatal hypoglycemia. Management typically involves careful monitoring of blood glucose levels, dietary modifications, and possibly insulin therapy to maintain optimal glycemic control. Fetal monitoring is crucial to assess fetal growth and well-being, particularly in the context of maternal diabetes, as it can influence delivery planning and neonatal care. Regular follow-ups with healthcare providers specializing in obstetrics and maternal-fetal medicine are essential for managing the complexities associated with diabetes in pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in diabetes types and management protocols
  • Need for precise documentation of maternal and fetal monitoring
  • Potential for multiple comorbidities affecting coding
  • Variations in treatment plans based on trimester and diabetes control

Audit Risk Factors

  • Inadequate documentation of diabetes type and management
  • Failure to document fetal monitoring results
  • Misclassification of gestational vs. pre-existing diabetes
  • Lack of clear treatment plans in medical records

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include detailed history of diabetes, treatment plans, and monitoring results.

Common Clinical Scenarios

Management of a pregnant patient with a known history of diabetes, requiring insulin adjustments and regular fetal assessments.

Billing Considerations

Coders must ensure clarity in distinguishing between pre-existing and gestational diabetes, as well as the specific trimester of care.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include comprehensive assessments of both maternal and fetal health.

Common Clinical Scenarios

Complex cases involving multiple risk factors, such as obesity or hypertension, alongside diabetes management.

Billing Considerations

Focus on the implications of diabetes on fetal development and the necessity for specialized monitoring and interventions.

Coding Guidelines

Inclusion Criteria

Use O24.319 When
  • Coders should follow official ICD
  • 10 guidelines, ensuring accurate documentation of the patient's diabetes history, treatment, and any complications
  • Specific criteria for pregnancy
  • related conditions must be adhered to, including trimester
  • specific coding when applicable

Exclusion Criteria

Do NOT use O24.319 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99203CPT Code

Office or other outpatient visit for the evaluation and management of a new patient

Clinical Scenario

Used for initial visits where diabetes management is discussed.

Documentation Requirements

Document the patient's diabetes history, current management, and any referrals.

Specialty Considerations

Ensure that the visit includes a comprehensive assessment of both maternal and fetal health.

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 claims and enhancing patient care through better data collection.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of diabetes in pregnancy, improving the accuracy of claims and enhancing patient care through better data collection.

Reimbursement & Billing Impact

reimbursement.

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 that was diagnosed before pregnancy, while gestational diabetes develops during pregnancy. Accurate coding is essential to reflect the patient's condition and management needs.