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E11.65
ICD-10-CM
Type 2 Diabetes Mellitus Uncontrolled

Find information on uncontrolled type 2 diabetes mellitus including diagnosis codes, clinical documentation requirements, and healthcare management guidelines. Learn about HbA1c targets, diabetes complications, and medical coding for uncontrolled T2DM. Explore resources for healthcare professionals on managing and documenting uncontrolled diabetes, covering insulin therapy, oral hypoglycemic agents, and patient education. This resource provides information on the ICD-10 code for uncontrolled diabetes and best practices for accurate clinical documentation.

Also known as

Uncontrolled Type 2 Diabetes
Type 2 Diabetes with Hyperglycemia
Type 2 Diabetes with Hypoglycemia

Diagnosis Snapshot

Key Facts
  • Definition : Chronic metabolic disorder with high blood sugar due to insulin resistance and relative insulin deficiency.
  • Clinical Signs : Frequent urination, excessive thirst, unexplained weight loss, blurred vision, fatigue, slow-healing sores.
  • Common Settings : Primary care, endocrinology, diabetes education programs, telehealth consultations.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC E11.65 Coding
E11

Type 2 diabetes mellitus

Encompasses various uncontrolled type 2 diabetes manifestations.

E11.65

Uncontrolled type 2 diabetes

Specifically identifies uncontrolled type 2 diabetes mellitus.

Z79.4

Long term (current) drug therapy

Indicates ongoing medication use, often relevant to diabetes management.

E11.9

Type 2 diabetes mellitus without complications

May be used if specific uncontrolled code is not applicable.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the patient diagnosed with Type 2 Diabetes Mellitus?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Type 2 Diabetes Uncontrolled
Diabetic Ketoacidosis
Hyperosmolar Hyperglycemic State

Documentation Best Practices

Documentation Checklist
  • Type 2 diabetes mellitus uncontrolled diagnosis documentation
  • ICD-10 E11.65 coding compliance: A1c, fasting glucose, OGTT
  • Document A1c value >6.5% on two occasions
  • Fasting glucose level >126 mg/dL documented twice
  • Oral glucose tolerance test >200 mg/dL two separate tests
  • Diabetes uncontrolled symptoms: polyuria, polydipsia

Coding and Audit Risks

Common Risks
  • Uncontrolled Criteria

    Lack of documented HbA1c, fasting glucose, or other criteria to support uncontrolled diabetes leads to coding and audit risk.

  • Comorbidity Coding

    Failing to capture related chronic kidney disease, neuropathy, retinopathy, or other complications impacts reimbursement and quality metrics.

  • Unspecified Documentation

    Vague documentation of symptoms and treatment without specific details makes accurate code assignment challenging, increasing compliance risks.

Mitigation Tips

Best Practices
  • Code Z71.4 for uncontrolled DM2, ICD-10 compliance.
  • Document A1c, blood glucose, meds, diet, exercise for CDI.
  • Educate patients on meds, diet, exercise for diabetes control.
  • Regular A1c monitoring & timely medication adjustments.
  • Improve patient compliance with lifestyle modifications.

Clinical Decision Support

Checklist
  • HbA1c >9.0% documented?
  • Fasting glucose >126 mg/dL (2 readings)?
  • Random glucose >200 mg/dL + symptoms?
  • Diabetes medication documented and active?
  • Patient education/follow-up scheduled?

Reimbursement and Quality Metrics

Impact Summary
  • Type 2 Diabetes Mellitus Uncontrolled reimbursement impacts coding accuracy, impacting hospital case mix index.
  • Accurate coding for uncontrolled diabetes maximizes reimbursement, reduces claim denials, improves revenue cycle.
  • Diabetes quality metrics like HbA1c control, eye exams, and nephropathy screening impact hospital reporting and value-based payments.
  • Uncontrolled diabetes coding affects hospital quality scores, impacting public rankings and potential penalties.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code E11.9, uncontrolled T2DM
  • Document A1c >9% or uncontrolled BG
  • Specify diabetic complications if present
  • Query physician if documentation unclear

Documentation Templates

Patient presents with uncontrolled type 2 diabetes mellitus.  Symptoms include persistent hyperglycemia, polyuria, polydipsia, and polyphagia.  The patient reports recent weight loss and fatigue.  HbA1c is elevated at [insert value, e.g., 9.5%], exceeding the target range for glycemic control.  Fasting blood glucose is also elevated at [insert value, e.g., 180 mg/dL].  Review of systems reveals complaints of blurred vision and intermittent paresthesia in the lower extremities, suggestive of diabetic neuropathy.  Past medical history includes hypertension, hyperlipidemia, and a family history of type 2 diabetes.  Current medications include [list current medications and dosages].  Physical examination reveals [insert relevant findings, e.g., acanthosis nigricans].  Assessment: Uncontrolled type 2 diabetes mellitus with associated hyperglycemia, indicative of insulin resistance and inadequate glycemic management.  Plan:  Discussed lifestyle modifications including dietary changes focusing on carbohydrate control and portion sizes, increased physical activity, and weight management strategies.  Medication regimen adjusted to optimize blood glucose control;  [insert specific changes, e.g., increased dosage of metformin to 1000 mg twice daily, initiation of basal insulin].  Patient education provided regarding diabetes self-management, including blood glucose monitoring and recognizing signs and symptoms of hypoglycemia and hyperglycemia.  Referral to a certified diabetes educator and registered dietitian recommended.  Follow-up scheduled in [timeframe, e.g., two weeks] to reassess glycemic control and adjust treatment plan as needed.  Diagnosis codes: E11.9, ICD-10-CM code for type 2 diabetes mellitus without complications;  Z79.4, ICD-10-CM code for long term current drug therapy.  Keywords: type 2 diabetes, uncontrolled diabetes, hyperglycemia, insulin resistance, diabetes management, HbA1c, fasting blood glucose, diabetic neuropathy, lifestyle modifications, medication management, diabetes education, medical nutrition therapy.