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ICD-10 Guide
ICD-10 CodesO24.81

O24.81

Billable

Other pre-existing diabetes mellitus in pregnancy

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

Code Description

ICD-10 O24.81 is a billable code used to indicate a diagnosis of other pre-existing diabetes mellitus in pregnancy.

Key Diagnostic Point:

O24.81 refers to cases of diabetes mellitus that existed prior to pregnancy and are managed during the gestational period. This condition can complicate pregnancy and requires careful monitoring and management to ensure the health of both the mother and the fetus. Women with pre-existing diabetes may experience increased risks of complications such as preeclampsia, macrosomia, and congenital anomalies. Management typically involves a multidisciplinary approach, including dietary modifications, blood glucose monitoring, and insulin therapy as needed. Regular fetal monitoring is essential to assess fetal growth and well-being, and to adjust maternal treatment plans accordingly. The goal is to maintain optimal glycemic control throughout pregnancy to minimize risks and ensure favorable outcomes for both mother and child.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in diabetes management protocols among providers
  • Need for precise documentation of blood glucose levels and insulin use
  • Potential for multiple comorbidities affecting pregnancy
  • Differentiation between types of diabetes and their management

Audit Risk Factors

  • Inadequate documentation of pre-existing diabetes management
  • Failure to document insulin type and dosage
  • Lack of fetal monitoring records
  • Inconsistent coding of diabetes type

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 type 1 diabetes requiring insulin adjustments.

Billing Considerations

Consideration of potential complications such as preeclampsia and fetal growth abnormalities.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of maternal-fetal assessments and interventions.

Common Clinical Scenarios

High-risk pregnancies involving pre-existing diabetes with additional complications.

Billing Considerations

Focus on advanced fetal monitoring techniques and potential interventions.

Coding Guidelines

Inclusion Criteria

Use O24.81 When
  • 10 coding guidelines for O24
  • 81 require accurate documentation of the patient's diabetes history, treatment regimen, and any complications arising during pregnancy
  • Coders must ensure that the code reflects the patient's condition accurately throughout the pregnancy

Exclusion Criteria

Do NOT use O24.81 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

Documentation must include assessment of diabetes management and any changes in treatment.

Specialty Considerations

Obstetricians should ensure comprehensive records of maternal health and fetal assessments.

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. O24.81 provides a clear distinction for pre-existing diabetes, enhancing clinical management and research capabilities.

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. O24.81 provides a clear distinction for pre-existing diabetes, enhancing clinical management and research capabilities.

Reimbursement & Billing Impact

reimbursement processes. O24.81 provides a clear distinction for pre-existing diabetes, enhancing clinical management and research capabilities.

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 correctly.