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v1.0.0
ICD-10 Guide
ICD-10 CodesO24.811

O24.811

Billable

Other pre-existing diabetes mellitus in pregnancy, first trimester

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

Code Description

ICD-10 O24.811 is a billable code used to indicate a diagnosis of other pre-existing diabetes mellitus in pregnancy, first trimester.

Key Diagnostic Point:

O24.811 refers to cases where a patient has pre-existing diabetes mellitus that is not classified as type 1 or type 2 and is diagnosed during the first trimester of pregnancy. This condition can complicate pregnancy due to the potential for hyperglycemia, which can lead to adverse outcomes for both the mother and fetus. Management typically involves careful monitoring of blood glucose levels, dietary modifications, and possibly insulin therapy to maintain glycemic control. Fetal monitoring is crucial to assess fetal growth and development, as well as to identify any potential complications early. The first trimester is a critical period for fetal organogenesis, making effective management of diabetes essential to minimize risks such as congenital anomalies and macrosomia. Regular follow-ups with healthcare providers specializing in obstetrics and maternal-fetal medicine are recommended to ensure optimal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of diabetes mellitus
  • Understanding the implications of pre-existing diabetes on pregnancy outcomes
  • Managing insulin therapy and dietary changes
  • Monitoring fetal development and potential complications

Audit Risk Factors

  • Inadequate documentation of diabetes management
  • Failure to document fetal monitoring results
  • Misclassification of diabetes type
  • Lack of follow-up notes on maternal and fetal health

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of blood glucose levels, insulin dosages, and dietary plans.

Common Clinical Scenarios

Patients with a history of diabetes presenting for prenatal care, requiring adjustments in management.

Billing Considerations

Ensure accurate coding of diabetes type and management strategies to avoid audit issues.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessments of maternal and fetal health, including ultrasound findings and growth assessments.

Common Clinical Scenarios

High-risk pregnancies due to pre-existing diabetes requiring specialized monitoring and intervention.

Billing Considerations

Focus on the implications of diabetes on fetal development and the need for multidisciplinary care.

Coding Guidelines

Inclusion Criteria

Use O24.811 When
  • Follow the official ICD
  • CM guidelines for coding diabetes in pregnancy, ensuring that the diabetes type is clearly documented and that the timing of the diagnosis is noted

Exclusion Criteria

Do NOT use O24.811 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 prenatal visits where diabetes management is discussed.

Documentation Requirements

Document the patient's history, examination findings, and management plan.

Specialty Considerations

Obstetricians should ensure that diabetes management is a focus of the visit.

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: Standards of Medical Care in Diabetes

Coding & Billing References

  • •
    American Diabetes Association: Standards of Medical Care in Diabetes

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 and typically resolves after delivery. Accurate coding is essential to reflect the patient's condition.