Metabolic Health
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Shifa Fathima

Know About ICD-11 Code for Diabetes

What are ICD Codes?

ICD or The International Classification of Diseases is a diagnostic tool maintained by the World Health Organization and used by physicians and other healthcare providers across the world to classify and code all diagnoses, symptoms, and procedures recorded.

The International Classification of Diseases (ICD) was started in the 19th century and has been the forerunner for comparing statistics and causes of mortality and morbidity between different places times. Since then, the codes have been in a continual state of improvement, resulting in a total of 11 versions released till date.

The latest version ‘ ICD-11’ was adopted in 2019 at the 72nd World Health Assembly and came into effect from 1st January 2022.  

Why are ICD Codes required?

  • The ICD Codes are a valuable tool for epidemiology, health management and clinical purposes.
  • It is the foundation for identifying health trends and is the international standard for reporting diseases and health conditions.
  • It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
  • Clinical terms coded with ICD are the main basis for health recording and statistics on disease in primary, secondary and tertiary care, as well as on cause of death certificates.
  • Diagnostic guidance linked to categories of ICD also standardizes data collection and enables large scale research.
  • Provides critical knowledge on the extent, causes and consequences of human disease and death worldwide.
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Who uses ICD Codes and for what purpose?

Global Organizations

Government health ministries and public health bodies use ICD Codes to assess and understand the current state of health for service planning, strategic health and safety policy decisions.

Medical Professionals

Physicians, healthcare providers, hospitals, and medical institutions around the world use ICD Codes to classify diseases, illnesses, injuries, procedures, develop standardized guidelines and in health services research.

Corporates

Insurance companies use ICD Codes and its information in payment systems, to process claims and reimbursements.

What is ICD 11?

The ICD-11 is the Eleventh Revision of the ICD Codes adopted in 2019 at the 72nd World Health Assembly and came into effect from 1st January 2022.  Similar to the other Ten predecessors that came before it, ICD-11 is also maintained by the WHO and employs unique alphanumeric numbers to designate recognized diseases and other health concerns.

ICD–11 allows countries to count and identify their most pressing health issues by using an up-to-date and clinically relevant classification system.ICD–11 is a vast improvement on previous revisions, and reflects critical advances in science and medicine. Used by doctors, coders, health information managers, nurses, and other healthcare workers, ICD-11 is more granular aligning classification with the latest knowledge of disease treatment and prevention, thus making it more meaningful than ICD–10.

What are the Guidelines for Using ICD-11 Codes For Diabetes

  • Structured as an Alphanumeric Code with a Letter in the second position and Number in the third character position.
  • The letters ‘O’ and ‘I’ are omitted to prevent confusion with numbers ‘0’ and ‘1’
  • There are Two Types of Codes - Stem Codes for Clinical entities that can be assigned alone and Extension Codes for adding more detail to the Stem Code. An extension code cannot be used alone and needs to mandatorily have a Stem code as its Prefix.
  • All entities in the classification will have a definition to ensure the common understanding of a
  • Diabetes-related pregnancy codes in the E08 to E13 range should be used after a code from the 024 categories for diabetic pregnant women.
  • Women should not be given any additional codes under the 024 category for gestational diabetes (diabetes that develops during pregnancy). Instead, they should be given a code under the 024.4 subsection.
  • E11 codes for type 2 diabetes should be used as a fallback if the person's type of diabetes is not specified in the medical record. The Type 2 diabetes codes should also be used if the person's medical record does not specify the person's type of diabetes but does note that the person utilizes insulin. In these circumstances, Z79.4—the code indicating long-term usage of insulin—should also be used (unless insulin was just given to the person as a one-time fix to bring blood sugar under control).
  • Keep in mind that the term "with" in the code titles never refers to two different circumstances; it always implies "related with" or "due to." When there is insufficient information to make a more precise diagnosis, the "unspecified" codes might be used; in this situation, "unspecified" is theoretically more accurate than a more specific but not yet verified diagnosis.

ICD-11 Codes for Diabetes Mellitus Based on Cause

Diabetes Mellitus is a metabolic disorder with heterogeneous etiologies, characterised by chronic hyperglycemia and disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

Condition : Type-1 Diabetes Mellitus

ICD 11 Code : 5A10  Type 1 Diabetes Mellitus

Definition : Diabetes mellitus type 1 (type 1 diabetes, T1DM, formerly insulin dependent or juvenile diabetes) is a form of diabetes mellitus that results from destruction of insulin-producing beta cells, mostly by autoimmune mechanisms. The subsequent lack of insulin leads to increased blood and urine glucose.

Condition : Type-2 Diabetes Mellitus

ICD 11 Code : 5A11  Type 1 Diabetes Mellitus

Definition : Formerly called Non-Insulin Dependent Diabetes Mellitus (NIDDM) or adult-onset diabetes is a metabolic disorder that is characterised by high blood glucose in the context of insulin resistance and relative insulin deficiency.

Condition : Malnutrition-related diabetes mellitus

ICD 11 Code : 5A12  Type 1 Diabetes Mellitus

Condition : Diabetes Mellitus – Other Specified Type

ICD 11 Code : 5A13 Diabetes Mellitus - Other Specified Type

Definition : Diabetes mellitus which cannot be classified as either Type 1 or Type 2 diabetes mellitus.

- 5A13.0 Diabetes mellitus due to genetic defects of beta cell function

- 5A13.1 Diabetes mellitus due to genetic defects in insulin action

- 5A13.2 Diabetes mellitus due to diseases of the exocrine pancreas

- 5A13.3 Diabetes mellitus due to endocrinopathies

- 5A13.4 Diabetes mellitus due to drug or chemical

- 5A13.5 Diabetes mellitus due to uncommon forms of immune-mediated diabetes

- 5A13.6 Diabetes mellitus due to other genetic syndromes

- 5A13.7 Diabetes mellitus due to clinically defined subtypes or syndromes

- 5A13.Y Diabetes mellitus due to other specified cause

- 5A14  Diabetes mellitus type unspecified

ICD-11 Codes for Diabetes Mellitus Based on Diagnosis

E11 Type 2 Diabetes Mellitus

E11.0 Type 2 diabetes mellitus with hyperosmolarity

E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma

E11.2 Type 2 Diabetes Mellitus with Kidney Complications

E11.21 Type 2 diabetes mellitus with diabetic nephropathy

E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease

E11.29 Type 2 diabetes mellitus with other diabetic kidney complication

E11.3 Type 2 Diabetes Mellitus with Ophthalmic Complications

E11.31 Type 2 diabetes mellitus with unspecified diabetic retinopathy

E11.32 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy

E11.33 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy

E11.34 Type 2 diabetes mellitus with severe non-proliferative diabetic retinopathy

E11.35 Type 2 diabetes mellitus with proliferative diabetic retinopathy

E11.36 Type 2 diabetes mellitus with diabetic cataract

E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication

E11.4 Type 2 Diabetes Mellitus with Neurological Complications

E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44 Type 2 diabetes mellitus with diabetic amyotrophy

E11.49 Type 2 diabetes mellitus with other diabetic neurological complication

E11.5 Type 2 Diabetes Mellitus with Circulatory Complications

E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene

E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene

E11.59 Type 2 diabetes mellitus with other circulatory complications

E11.6 Type 2 Diabetes Mellitus with Other Specified Complications

E11.61 Type 2 diabetes mellitus with diabetic arthropathy

E11.62 Type 2 diabetes mellitus with skin complications

E11.63 Type 2 diabetes mellitus with oral complications

E11.64 Type 2 diabetes mellitus with hypoglycemia

E11.65 Type 2 diabetes mellitus with hyperglycemia

E11.69 Type 2 diabetes mellitus with other specified complication

E11.8 Type 2 Diabetes Mellitus with Unspecified Complications

E11.9 Type 2 Diabetes Mellitus without Complications

Bottomline

ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a classification and coding system used by U.S. healthcare providers. It is based on the World Health Organization's International Classification of Illnesses. ICD data are utilized in the generation of national mortality and morbidity statistics. Diabetes-related pregnancy codes in the E08 to E13 range should be used after a code from the 024 categories for diabetic pregnant person. Type 2 diabetes codes should also be used if the person's medical record does not specify the type of diabetes. When there is insufficient information to make a more precise diagnosis, the "unspecified" codes might be used.

FAQs

What is the  ICD-11 Code for Type-2 Diabetes?

The ICD-11 Code for Type 2 Diabetes Mellitus is 5A11

What Is the ICD Code For Metformin Use?

The ICD-10 code for long term use of oral hypoglycemic drugs is Z79. 84

What Is The  ICD-11 Code For Diabetes With Hypertension?

E11. 22, Type 2 diabetes mellitus with diabetic CKD.

I12. 9, hypertensive CKD with stage 1 through 4 CKD, or unspecified CKD

What is the ICD Code for Use of Insulin?

The ICD code for Type 2 Diabetes Mellitus with Long-term (current) use of Insulin should be Z79.4 (Category E11 Codes)

For Type 1 diabetes mellitus there is no need to record a Z code for long-term insulin usage since the diagnosis itself implies the need for lifelong insulin.

References

  • https://www.medicalbillersandcoders.com/blog/icd-10-codes-type-2-diabetes-mellitus/

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