236 JAMA: The Journal of the American Medical Association recently published research on the prevalence of diabetes mellitus types 1 and 2 among children and adolescents show- ing a 21% increase in type 1 and 30.5% increase in type 2 diabetes between 2001 and 2009.1 This increase in the number of children presenting with diabetes indicates that pediatricians are more frequently diagnosing and caring for children with diabetes. This is good reason to review the future of diagnosis coding for these conditions: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Most physicians are familiar with International Classification of Diseases, Ninth Revision, Clinical Modification codes in the 250 category that include diabetes mellitus types 1 and 2. The fourth and fifth digits of these codes identify manifestations, type of diabetes, and control status. ICD-10-CM addresses diabetes by type, identifying each type with a sepa- rate code category. For example, type 1 diabetes is reported with a code from category E10, while type 2 diabetes is reported with a code from category E11. Each category includes combination codes that identify the type of diabetes and a body system affected by manifestation of the disease. Additional codes may be required to further describe some manifestations. Control status is only included in ICD-10-CM classification of diabetes when the condi- tion is documented with terms indicating poor control or lack of control. ICD-10-CM guidelines for reporting diabetes state that diabetes noted as poorly controlled or uncon- trolled are to be reported with the code for the type of diabetes with hyperglycemia (eg, E10.65, type 1 diabetes with hyperglycemia). This guideline applies to all types of diabetes. Hypo-glycemia in diabetes is reported with a combination code that identifies the type of diabetic hypoglycemia with or without coma (eg, E10.649, type 1 diabetes with hypoglyce- mia without coma). Examples A teenager with type 1 diabetes diagnosed 6 years ago presents for regularly scheduled follow-up care. At an encounter 3 months prior, urine examination was positive for microalbuminuria. Repeat testing is again positive for microalbuminuria. The current hemoglobin A1c result is 8.5. The diagnoses are uncontrolled type 1 diabetes with nephro- pathy and microalbuminuria. ICD-10-CM codes reported are E10.65 Type 1 diabetes mellitus with hyperglycemia E10.21 Type 1 diabetes mellitus with diabetic nephropathy R80.9 Proteinuria, unspecified (includes microalbuminuria) A teenaged girl with diabetes is seen in the physician office to follow up a recent emergency department visit for hypoglycemia. The girl states she has been busy with school activities and sports that distract from her normal routine, making it more difficult to manage her diabetes. She states she doesn’t feel the warning signs of hypoglycemia as she had Appendix B-6 Documenting Diabetes Mellitus
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