Superb Diabetes ICD 10 Coding tips for Pregnancy Chapter

Diabetes mellitus is one of the most common chronic disease in old age. In medical coding, the diagnosis coding for normal women and pregnant women has separate coding guidelines. This disease has a  significant complicating factor in pregnancy.

We have learned  a lot of Pregnancy ICD and CPT codes, you can find some information about them in below links.

Use of Pregnancy Complication ICD 10 codes

When to use Normal Pregnancy and Incidental Pregnancy ICD 10 codes

Coding Guidelines for Z3A category codes

Twin Pregnancy ICD and CPT codes

There is a separate category of ICD 10 codes for diabetes in pregnancy condition. Pregnant women who are diabetic should be assigned a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08–E13) from chapter 4 of ICD-10-CM.

There are specific ICD 10 codes for diabetes mellitus in pregnancy chapter, below are few examples:

O24.011–O24.03  Pre-existing type 1 diabetes mellitus

O24.011–O24.13    Pre-existing type 2 diabetes mellitus

O24.311–O24.319  Unspecified pre-existing diabetes mellitus

O24.410–O24.439    Gestational diabetes mellitus

O24.811–O24.83    Other pre-existing diabetes mellitus

O24.911–O24.93    Unspecified diabetes mellitus

Diabetes Coding tips for Pregnancy for Medical coders

Read also: Coding tips for Ectopic and Molar Pregnancy ICD and CPT codes

When to use Gestational diabetes ICD 10 codes

               
Gestational Diabetes is diabetes developed during pregnancy. Women with Gestational Diabetes are at risk for developing Type 2 Diabetes later in life. Gestational (pregnancy-induced) diabetes can occur during the second and third trimesters of pregnancy in women who were not diabetic prior to pregnancy.
Women with gestational diabetes are at increased risk to develop diabetes mellitus following delivery. Codes for gestational diabetes are in subcategory O24.4, Gestational diabetes mellitus. No other code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, should be used with a code from O24.4.
The codes under subcategory O24.4 include diet controlled, insulin controlled, and controlled by oral hypoglycemic drugs.
If a patient with gestational diabetes is treated with both diet and insulin, only the code for insulin controlled is required. Code Z79.4, is used for Long-term (current) use of insulin.
If a patient with gestational diabetes is treated with both diet and oral hypoglycemic drugs, only the code for “controlled by oral hypoglycemic drugs” is required. Code Z79.84, should be used for Long-term (current) use of oral hypoglycemic drugs.

Use of Z codes for Screening, Insulin, hypoglycemic drugs & weeks of Gestation

There are also major use of Z codes along with diabetes mellitus diagnosis codes. The Code Z79.4, Long-term (current) use of insulin, has to be assigned if the pre-existing or unspecified diabetes mellitus is being treated with insulin. But when the insulin is used only for temporary use, do not use Z79.4, it should be used for long-term use only. 

Similarly when a the patient is taking oral hypoglycemic drug like Metformin, we have to assign Z79.84, Long-term (current) use of oral hypoglycemic drugs, when the  pre-existing or unspecified diabetes mell

However, neither code Z79.4 nor code Z79.84 should be assigned with codes from subcategory O24.4, Gestational diabetes. If a patient with gestational diabetes is medication controlled, the appropriate medication-controlled code O24.414, O24.415, O24.424, O24.425, O24.434, or O24.435 should be assigned instead of Z79.4 or Z79.84. Code Z86.32, Personal history of gestational diabetes, is assigned to indicate that a patient has a history of gestational diabetes in a previous pregnancy.

A pregnant patient may have an abnormal glucose tolerance and not be diagnosed with gestational diabetes. In such cases, a code from subcategory O99.81, Abnormal glucose complicating pregnancy, childbirth, and the puerperium, should be assigned instead.

When reporting complication of a pregnant patient, along with the trimester you will need to report the specific week of gestation as well. Use additional code from category Z3A (weeks of gestation) to identify the specific week of the pregnancy. 

Z13.1 Encounter for screening for diabetes mellitus

2 Thoughts to “Superb Diabetes ICD 10 Coding tips for Pregnancy Chapter”

  1. Koumba Epperson

    Thank you for this post! I have a question about the pre-existing and unspecified diabetes in pregnancy codes. If the physician states that patient has pre-existing diabetes but doesn’t state if it is type 1 or 2, we generally default to type 2. Is this the same in the pregnancy codes? What would be the difference between O24.011 (pre-existing type 2) and O24.311 (unspecified) if the physician doesn’t list the type?

    O24.011 + E11.9 or O24.311 + E11.9

    Thank you!

    1. Hi Koumba,
      you have asked a very good question…as per coding guidelines…the pre-existing diabetes code (024 category) should be followed by a an diabetes code from series of E10 or E11 category code. Now, to answer your query, a unspecified pre-existing diabetes should be reported as unspecified only from 024 category, followed by a type 2 diabetes from from E11 category. We cannot assume a type 2 diabetes for coding pre-existing diabetes.
      Hope this will resolve your query.

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