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ICD-10 Guide
ICD-10 CodesO24.419

O24.419

Billable

Gestational diabetes mellitus in pregnancy, unspecified control

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

Code Description

ICD-10 O24.419 is a billable code used to indicate a diagnosis of gestational diabetes mellitus in pregnancy, unspecified control.

Key Diagnostic Point:

Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance that is first recognized during pregnancy. It typically arises due to hormonal changes that affect insulin sensitivity, leading to elevated blood glucose levels. GDM can pose risks to both the mother and fetus, including increased likelihood of cesarean delivery, macrosomia, and neonatal hypoglycemia. Management of GDM often involves dietary modifications, blood glucose monitoring, and, in some cases, insulin therapy. The term 'unspecified control' indicates that the patient's blood glucose levels are not well-controlled, necessitating close monitoring and potential adjustments in treatment. Regular fetal monitoring is essential to assess fetal growth and well-being, as well as to identify any complications early. The condition usually resolves after delivery, but women with GDM are at higher risk for developing type 2 diabetes later in life. Accurate coding of GDM is crucial for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and management of GDM.
  • Need for precise documentation of blood glucose levels and control measures.
  • Differentiation from pre-existing diabetes and other types of diabetes.
  • Potential for complications requiring additional coding.

Audit Risk Factors

  • Inadequate documentation of blood glucose levels.
  • Failure to document treatment plans and patient compliance.
  • Misclassification of GDM as type 1 or type 2 diabetes.
  • Lack of follow-up documentation post-delivery.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include details on glucose testing results, dietary management, and any insulin therapy prescribed.

Common Clinical Scenarios

Patients diagnosed with GDM during routine screening, management of GDM with insulin, and monitoring of fetal growth in GDM pregnancies.

Billing Considerations

Ensure that all aspects of GDM management are documented, including patient education and follow-up plans.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include comprehensive assessments of maternal and fetal health, including ultrasound findings and any interventions.

Common Clinical Scenarios

Management of GDM in patients with additional risk factors such as obesity or previous GDM history.

Billing Considerations

Focus on detailed fetal monitoring and potential complications associated with GDM.

Coding Guidelines

Inclusion Criteria

Use O24.419 When
  • Follow the official ICD
  • CM guidelines for coding diabetes in pregnancy, ensuring that the specific type of diabetes and control status are accurately documented
  • Use additional codes for any complications arising from GDM

Exclusion Criteria

Do NOT use O24.419 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, level 3

Clinical Scenario

Used for follow-up visits for GDM management.

Documentation Requirements

Document blood glucose levels, dietary adherence, and any changes in treatment.

Specialty Considerations

Obstetricians should ensure comprehensive documentation of the patient's progress.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gestational diabetes, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of maternal and fetal outcomes associated with GDM.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gestational diabetes, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of maternal and fetal outcomes associated with GDM.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of maternal and fetal outcomes associated with GDM.

Resources

Clinical References

  • •
    American Diabetes Association: Gestational Diabetes

Coding & Billing References

  • •
    American Diabetes Association: Gestational Diabetes

Frequently Asked Questions

What is the difference between gestational diabetes and pre-existing diabetes?

Gestational diabetes occurs during pregnancy and typically resolves after delivery, while pre-existing diabetes is a chronic condition that exists before pregnancy. Accurate coding is essential to differentiate between the two for appropriate management and care.