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ICD-10 Guide
ICD-10 CodesO24.1

O24.1

Billable

Pre-existing type 2 diabetes mellitus, in pregnancy, childbirth and the puerperium

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

Code Description

ICD-10 O24.1 is a billable code used to indicate a diagnosis of pre-existing type 2 diabetes mellitus, in pregnancy, childbirth and the puerperium.

Key Diagnostic Point:

Pre-existing type 2 diabetes mellitus in pregnancy poses significant risks to both the mother and fetus. Women with this condition require careful management throughout their pregnancy to mitigate complications such as gestational hypertension, preeclampsia, and fetal macrosomia. Insulin management is crucial, as many women may need adjustments to their insulin regimen to maintain optimal glycemic control. Regular fetal monitoring is essential to assess fetal growth and well-being, as uncontrolled diabetes can lead to adverse outcomes such as congenital anomalies and stillbirth. Healthcare providers must ensure that blood glucose levels are closely monitored, and dietary modifications are implemented. Education on self-monitoring of blood glucose and recognizing signs of hyperglycemia or hypoglycemia is vital. The postpartum period also requires attention, as women may experience changes in insulin sensitivity and need ongoing monitoring for diabetes management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for precise documentation of pre-existing conditions and their management.
  • Variability in insulin management protocols among different providers.
  • Potential for multiple comorbidities affecting pregnancy outcomes.
  • Importance of accurate fetal monitoring and documentation of findings.

Audit Risk Factors

  • Inadequate documentation of blood glucose monitoring.
  • Failure to document changes in insulin therapy.
  • Lack of detailed fetal monitoring records.
  • Insufficient documentation of patient education and self-management strategies.

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 a pregnant patient with type 2 diabetes requiring insulin therapy and regular fetal assessments.

Billing Considerations

Ensure comprehensive documentation of all interventions and patient education related to diabetes management.

Maternal-Fetal Medicine

Documentation Requirements

Thorough documentation of high-risk assessments, including ultrasound findings and maternal-fetal interactions.

Common Clinical Scenarios

Monitoring a high-risk pregnancy with pre-existing type 2 diabetes and associated complications.

Billing Considerations

Focus on detailed documentation of fetal growth patterns and maternal health changes.

Coding Guidelines

Inclusion Criteria

Use O24.1 When
  • Follow official ICD
  • 10 guidelines for coding diabetes in pregnancy, ensuring accurate documentation of the type of diabetes and any associated complications

Exclusion Criteria

Do NOT use O24.1 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 patient's diabetes management plan, blood glucose levels, and any changes in therapy.

Specialty Considerations

Obstetricians should coordinate care with endocrinologists for optimal 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: 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 type 2 diabetes and gestational diabetes?

Pre-existing type 2 diabetes is a chronic condition that exists before pregnancy, while gestational diabetes develops during pregnancy and typically resolves after delivery. Accurate coding is essential to reflect the patient's condition correctly.