Question

How to code diabetes

Answer 1

Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89). Diabetes mellitus codes falls within the code range E08-E13. These chapter-specific diabetes guidelines contain six primary criteria:

Type of diabetes

Type of diabetes mellitus not documented

Diabetes mellitus and the use of insulin and oral hypoglycemic

Diabetes mellitus in pregnancy and gestational diabetes

Complications due to insulin pump malfunction
(a) Underdose of insulin due to insulin pump failure
(b) Overdoes of insulin due to insulin pump failure

Secondary diabetes mellitus
(a) Secondary diabetes mellitus and the use of insulin or oral hypoglycemic drugs
(b) Assigning and sequencing secondary diabetes codes and causes
(i) Secondary diabetes mellitus due to pancreatectomy
(ii) Secondary diabetes due to drugs

New revisions for 2018 are the following two sections (3 and 6) for the coding of diabetes (the bolded wording represents the additions/revisions for FY2018):

3) Diabetes mellitus and the use of insulin and oral hypoglycemics
If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11-, Type 2 diabetes mellitus, should be assigned. An additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs. If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.

6) Secondary diabetes mellitus
Codes under categories E08, Diabetes mellitus due to underlying condition, E09, Drug- or chemical-induced diabetes mellitus, and E13, Other specified diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).


(a) Secondary diabetes mellitus and the use of insulin or oral hypoglycemic drugs
For patients with secondary diabetes mellitus who routinely use insulin or oral hypoglycemic drugs, an additional code from category Z79 should be assigned to identify the long-term (current) use of insulin or oral hypoglycemic drugs. If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.