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ICD-10 Guide
ICD-10 CodesO24.813

O24.813

Billable

Other pre-existing diabetes mellitus in pregnancy, third trimester

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

Code Description

ICD-10 O24.813 is a billable code used to indicate a diagnosis of other pre-existing diabetes mellitus in pregnancy, third trimester.

Key Diagnostic Point:

O24.813 refers to cases where a patient has pre-existing diabetes mellitus that is not classified as type 1 or type 2 diabetes and is experiencing this condition during the third trimester of pregnancy. This condition requires careful management to mitigate risks to both the mother and fetus. Women with pre-existing diabetes may face complications such as hypertensive disorders, increased risk of cesarean delivery, and fetal macrosomia. Insulin management is crucial, as blood glucose levels must be closely monitored and controlled to prevent adverse outcomes. Fetal monitoring is also essential, as it helps assess fetal well-being and detect any potential complications early. Regular ultrasounds and non-stress tests may be employed to monitor fetal growth and heart rate patterns. The management of diabetes in pregnancy involves a multidisciplinary approach, including obstetricians, endocrinologists, and dietitians, to ensure optimal maternal and fetal health.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between types of diabetes mellitus
  • Managing insulin therapy adjustments during pregnancy
  • Monitoring for potential complications in both mother and fetus
  • Understanding the implications of diabetes on labor and delivery

Audit Risk Factors

  • Inadequate documentation of diabetes management plans
  • Failure to document fetal monitoring results
  • Lack of clear differentiation between types of diabetes
  • Insufficient detail on insulin therapy adjustments

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal health, diabetes management, and fetal monitoring are essential. Documentation should include glucose levels, insulin dosages, and any complications.

Common Clinical Scenarios

Patients with pre-existing diabetes presenting for routine prenatal visits, management of insulin therapy, and monitoring for fetal growth abnormalities.

Billing Considerations

Coders must ensure that all aspects of diabetes management are documented, including any changes in treatment plans and outcomes.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors, including maternal age, weight, and any additional comorbidities.

Common Clinical Scenarios

High-risk pregnancies requiring specialized monitoring and interventions, such as frequent ultrasounds and non-stress tests.

Billing Considerations

Attention to detail in documenting the rationale for increased monitoring and interventions is crucial.

Coding Guidelines

Inclusion Criteria

Use O24.813 When
  • Coders should refer to the official ICD
  • CM guidelines for obstetric coding, which emphasize the importance of specificity in documenting the type of diabetes and its management during pregnancy
  • Additionally, guidelines for coding complications and co
  • existing conditions must be adhered to

Exclusion Criteria

Do NOT use O24.813 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 patients with pre-existing diabetes in pregnancy.

Documentation Requirements

Document the patient's diabetes management, including glucose levels and any changes in treatment.

Specialty Considerations

Obstetricians should ensure that all aspects of diabetes care are addressed during visits.

76815CPT Code

Ultrasound, fetal biometry

Clinical Scenario

Used to monitor fetal growth in patients with pre-existing diabetes.

Documentation Requirements

Document the findings of the ultrasound and any implications for management.

Specialty Considerations

Maternal-fetal medicine specialists should provide detailed reports on fetal growth patterns.

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. O24.813 provides a clear distinction for cases of pre-existing diabetes, which is essential for appropriate management and care.

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. O24.813 provides a clear distinction for cases of pre-existing diabetes, which is essential for appropriate management and care.

Reimbursement & Billing Impact

reimbursement processes. O24.813 provides a clear distinction for cases of pre-existing diabetes, which is essential for appropriate management and care.

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 differentiate between the two, as management and implications for maternal and fetal health differ significantly.