Clinical documentation improvement needed to code diabetes mellitus in ICD-10-CM

We’re all thinking about documentation specificity needs in ICD-10-CM/PCS as we prepare of the October 1, 2014 compliance deadline. Increased communication between physicians and coders is paramount to success. Increased understanding of the documentation needs for ICD-10-CM includes the diagnosis of diabetes mellitus.

Diabetes mellitus is a disorder of the endocrine portion of the pancreas. It is actually a group of metabolic disorders characterized by high blood sugar caused by a lack of insulin secretion by the pancreas. Blood sugars are normally tightly controlled by the secretion of insulin that keeps the blood glucose with a normal range. Insufficient insulin is the primary cause of Type I diabetes.

Type II diabetes is caused by insulin resistance. Even though an adequate amount of insulin is produced the body is unable to effectively use it.

Other causes of diabetes include an underlying condition, such as:

• Cushing’s syndrome
• Malignant neoplasms
• Pancreatitis

People may also suffer from drug or chemical induced diabetes. Gestational diabetes is a complication of pregnancy.

Untreated diabetes leads to adverse effects on other body systems including eyes, kidneys, circulatory system, and nervous system.

Compare the diabetes codes in ICD-9-CM and ICD-10-CM :

In ICD-9-CM, diabetes mellitus appears in code categories 249-250. ICD-9-CM classifies diabetes as:

• Type I
• Type 2
• Secondary

Secondary diabetes is due to an underlying condition. Type 2 diabetes is not synonymous with secondary diabetes.

The fourth digit indicates the presence of manifestations or complications.

The fifth digit indicates the type of diabetes mellitus or unspecified diabetes and also whether it is uncontrolled or not stated as uncontrolled.

In ICD-10-CM, diabetes mellitus appears in code categories E08-E13. Classified as follows:

• E08, diabetes mellitus due to an underlying condition. Note this category of codes is prefaced by an instructional note stating to code first the underlying condition.
• E09, drug or chemically induced diabetes mellitus. This category includes diabetes mellitus due to various types of drugs and chemicals. An instructional note states that the code to identify the drug or chemical should be assigned first.
• E10, Type I diabetes mellitus.
• E11, Type 2 or diabetes not otherwise specified. E11 is the default when the type of diabetes is not specified in the documentation.
• E13, other specified diabetes mellitus. This category of codes denotes diabetes mellitus that occurs due to some other specified reason that is not an underlying condition or due to a drug or chemical.

Where is E12? Most likely the absence of E12 is intentional just in case a brand new category is created in the future. This is an example of ICD-10-CM’s ability to expand.