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E11.36
ICD-10-CM
Type 2 Diabetes Mellitus with Cataract

Find information on Type 2 Diabetes Mellitus with Cataract diagnosis, including ICD-10 codes E11 and H28, clinical documentation improvement tips, and healthcare guidelines. Learn about the connection between diabetes and cataracts, diabetic retinopathy risk factors, and medical coding best practices for accurate reimbursement. Explore resources for healthcare professionals on managing patients with both conditions, including treatment options and preventative care.

Also known as

Diabetic Cataract in Type 2 Diabetes
Type 2 DM with Cataract

Diagnosis Snapshot

Key Facts
  • Definition : Chronic metabolic disorder characterized by high blood sugar due to insulin resistance and relative insulin deficiency.
  • Clinical Signs : Increased thirst, frequent urination, blurred vision, fatigue, slow healing wounds.
  • Common Settings : Primary care clinics, endocrinology, ophthalmology, diabetes education programs.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC E11.36 Coding
E11-E14

Type 2 Diabetes Mellitus

Covers various forms of type 2 diabetes.

H25-H28

Cataract

Includes different types of cataracts.

E10-E14

Diabetes Mellitus

Encompasses both type 1 and type 2 diabetes.

Code-Specific Guidance

Decision Tree for

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

Is the cataract related to diabetes?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Type 2 Diabetes with Cataract
Diabetic Retinopathy
Diabetic Nephropathy

Documentation Best Practices

Documentation Checklist
  • Diabetes Type 2 with Cataract diagnosis documentation
  • Confirm T2DM diagnosis: HbA1c, FPG, OGTT results
  • Cataract type (e.g., nuclear, cortical) and laterality
  • Visual acuity assessment for each eye documented
  • Impact of cataract on patient's daily activities

Coding and Audit Risks

Common Risks
  • Unlinked Cataract

    Cataract may be age-related, not diabetic. Code both but ensure documentation supports diabetes link for accurate risk adjustment.

  • Unspecified DM Type

    Coding E11.- requires specificity (E11.9). Unspecified type impacts quality reporting and reimbursement.

  • Missing Manifestations

    Documenting cataract type (e.g., H26.9) and DM manifestations improves coding specificity and care planning.

Mitigation Tips

Best Practices
  • Annual eye exams, HbA1c control for diabetic retinopathy. ICD-10 E11.3, H28.0. CDI, HCC coding.
  • Optimize blood sugar, BP. Cataract surgery timing crucial. ICD-10 E11.3, H25.8, H26.9, IOL implant Z96.5
  • Patient education on diabetes management, eye health. SNOMED CT 73211009, 367665002. Compliance, risk adjustment.
  • Timely cataract surgery improves vision, quality of life. Post-op glucose control essential. HEDIS, MIPS.
  • Regular follow-up with ophthalmologist, endocrinologist. Interprofessional communication. ICD-10 Z72.4

Clinical Decision Support

Checklist
  • 1. HbA1c >= 6.5% or FPG >= 126 mg/dL (ICD-10 E11.9)
  • 2. Opacity of eye lens (ICD-10 H26.9) documented
  • 3. Retinal exam performed, diabetic retinopathy assessed (ICD-10 E11.3)
  • 4. Patient education on diabetes management and eye care provided
  • 5. Referral to ophthalmologist for cataract evaluation/management

Reimbursement and Quality Metrics

Impact Summary
  • Type 2 Diabetes Mellitus with Cataract: Reimbursement and Quality Metrics Impact Summary
  • ICD-10-CM Coding: E11.35, H26.9 affects DRG assignment and reimbursement.
  • Accurate coding impacts quality reporting on diabetes management and eye care.
  • HCC coding for risk adjustment and appropriate reimbursement is crucial.
  • Diabetes and cataract comorbidity influences hospital quality scores and outcomes.

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 first, then H28
  • Diabetes type 2 with cataract
  • Document lens opacity type
  • ICD-10-CM coding guidelines
  • Query physician if unclear

Documentation Templates

Patient presents with symptoms consistent with Type 2 Diabetes Mellitus and bilateral cataracts.  The patient reports blurred vision, increased glare, and difficulty with night driving.  Additionally, the patient experiences polyuria, polydipsia, and polyphagia.  Review of systems reveals fatigue and occasional paresthesia.  Past medical history is significant for hypertension and hyperlipidemia.  Family history is positive for Type 2 Diabetes.  Physical examination reveals decreased visual acuity in both eyes, lens opacities observed upon slit-lamp examination, and elevated blood pressure.  Laboratory results indicate elevated HbA1c (7.8%), fasting blood glucose (160 mgdL), and elevated cholesterol.  Diagnosis of Type 2 Diabetes Mellitus with bilateral cataracts is confirmed.  Treatment plan includes initiation of metformin for glycemic control, lifestyle modifications including diet and exercise, referral to ophthalmology for cataract surgery evaluation and management, and continued monitoring of blood glucose, HbA1c, lipid panel, and blood pressure.  Patient education provided on diabetes management, including medication adherence, self-monitoring of blood glucose, and importance of regular eye exams.  Follow-up appointment scheduled in three months to assess treatment efficacy and disease progression.  ICD-10 codes E11.9 and H26.9 assigned.  Medical billing codes for diabetes management and cataract evaluation and management will be applied accordingly.