ICD-10 Guide

Hga1C

ICD-10 Coding for HbA1c(E11.65, R73.09)

PRIMARY SPECIALTYEndocrinology

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Hga1C?

Essential facts and insights about HbA1c

Key Clinical Considerations:

Elevated blood glucose levels
HbA1c test results indicating poor glycemic control
Symptoms of diabetes such as increased thirst, frequent urination, and fatigue

Clinical Information

Clinical Criteria & Documentation Requirements

Patient's HbA1c levels and date of testing
History of diabetes management and treatment plans
Evidence of physical exam findings related to diabetes complications

Coding Guidelines

Usage Guidelines & Examples

Follow guidelines for differentiating between Type 1 and Type 2 diabetes.
Common errors include misclassifying diabetes type or omitting complications.

Code Exclusions

Important Exclusions

Gestational diabetes (O24.4)
Diabetes due to other specific conditions (E08, E09)

Specialty Focus

Primary Specialty

Endocrinology

Specialty Applications

Adults and children diagnosed with diabetes
Endocrinology clinics and primary care settings

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What are the documentation requirements?

Document HbA1c levels, treatment history, and any related complications.

What are the billing considerations?

Ensure accurate coding based on the type of diabetes and any associated conditions.

Hga1C

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What are the documentation requirements?

What are the billing considerations?

Hga1C

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What are the documentation requirements?

What are the billing considerations?