237 There is currently no code specifying hypoglycemic unawareness. If the cause of the hypoglycemic unawareness is noted as diabetic autonomic neuropathy, code E10.43 (type 1 diabetes mellitus with diabetic autonomic [poly]neuropathy) may be reported in addition to code E10.649. Coding Tip Insulin use is assumed in type 1 diabetes, making it unnecessary to report an additional code. When the patient with another type of diabetes uses insulin (long term), code Z79.4 should be reported to indicate the long-term current use of insulin. Temporary administration of insulin during an encounter should not be separately reported. Prediabetes or other abnormal glucose without diagnosis of diabetes is reported with code R73.09. Dietary counseling and surveillance may be reported with code Z71.3. Categories E08, E09, and E13 are used to report secondary diabetes. The ICD-10-CM tab-ular list provides instruction on sequencing of codes for these conditions. When diabetes is due to an underlying condition, the code for the underlying condition is reported first (eg, cystic fibrosis). Identified poisoning or adverse effect by drug or toxin should be reported in conjunction with the codes for drug- or chemical-induced diabetes (category E09). Sequencing of codes for drug- or chemical-induced diabetes is dependent on whether the patient experienced poisoning or an adverse effect of a properly administered substance. Category E13 includes postoperative diabetes and diabetes due to genetic defects of beta cell function or insulin action. For patients who are pregnant and have preexisting or gestational diabetes, Chapter 15 of the ICD-10-CM tabular list (O codes) includes pregnancy codes specific to type of diabe- tes. Furthermore, like many ICD-10-CM pregnancy codes, conditions are also specified by trimester. For example, the code series O24.01X addresses preexisting type 1 diabetes specific to trimesters 1, 2, or 3, and the code series O24.11X addresses preexisting type 2 diabetes also specific to trimester. To these, one may add additional secondary codes to specify any additional diabetic manifestations (eg, codes from category E10 or E11). The O24.41X code series addresses gestational diabetes in pregnancy, but rather than being specific to trimester, gestational diabetes is referenced by diet or insulin control. Additional codes in category O24 are assigned for gestational diabetes in childbirth or the puerperium. ICD-10-CM also includes codes for reporting the syndrome of an infant of a mother with gestational (P70.0) or preexisting (P70.1) diabetes. When documenting diabetes, key elements for code selection are type and manifestations. If the type of diabetes is not documented, a code for type 2 is reported. Type 1 and other types of diabetes should be documented accordingly. Codes for each manifestation of diabetes should be reported. Coders may not assume a relationship between diabetes and other documented conditions. For this reason, it is important that manifestations are clearly indicated in the record (eg, diabetic skin ulcer or neuropathy due to diabetes). previously. The diagnosis is type 1 diabetes with hypoglycemia and hypoglycemic unawareness. The ICD-10-CM code reported is E10.649 Type 1 diabetes mellitus with hypoglycemia without coma (continued on page 238)
Previous Page Next Page