Find information on uncontrolled diabetes mellitus, including clinical documentation tips, ICD-10 codes (E11.65, E11.9), medical coding guidelines, and healthcare resources for managing uncontrolled diabetes. Learn about diagnosing and documenting hyperglycemia, long-term complications, and best practices for patient care with uncontrolled diabetes. This resource provides valuable information for physicians, nurses, coders, and other healthcare professionals dealing with uncontrolled diabetes mellitus.
Also known as
Diabetes mellitus
Covers various types of diabetes with uncontrolled or poorly controlled designations.
Diabetes mellitus due to other specified
Diabetes due to underlying conditions, potentially contributing to uncontrolled status.
Long term current drug therapy
Indicates ongoing medication use, relevant for uncontrolled diabetes requiring management.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the diabetes Type 1?
Yes
With coma?
No
Is the diabetes Type 2?
When to use each related code
| Description |
|---|
| Uncontrolled diabetes |
| Hyperglycemia |
| Brittle diabetes |
Coding E11.9 (unspecified) without documented type (I or II) creates HCC coding risk and impacts RAF scores.
Insufficient documentation of A1c, blood glucose levels, or medication adherence may lead to undercoding severity and rejected claims.
Missing documentation linking chronic complications (retinopathy, neuropathy) to diabetes impacts accurate risk adjustment and reimbursement.
Q: What are the most effective strategies for addressing persistent hyperglycemia in patients with uncontrolled type 2 diabetes mellitus despite adherence to metformin and lifestyle modifications?
A: Persistent hyperglycemia despite metformin and lifestyle interventions often necessitates escalating therapy. Evidence-based strategies include adding a second-line oral antidiabetic agent such as a sulfonylurea (e.g., glipizide), a DPP-4 inhibitor (e.g., sitagliptin), or an SGLT2 inhibitor (e.g., empagliflozin). GLP-1 receptor agonists (e.g., semaglutide) are also highly effective and may be preferred for patients with obesity or cardiovascular risk factors. Consider patient-specific factors such as comorbidities, cost, and potential adverse effects when choosing the next agent. Insulin therapy should be considered if oral agents prove insufficient or in cases of significant hyperglycemia. Regular monitoring of HbA1c and blood glucose is crucial to assess treatment response and guide adjustments. Explore how individualized combination therapy can optimize glycemic control and minimize risks. Learn more about the latest ADA guidelines for managing uncontrolled diabetes.
Q: How can clinicians effectively differentiate between uncontrolled type 1 diabetes mellitus and latent autoimmune diabetes in adults (LADA) to ensure appropriate management?
A: Differentiating between uncontrolled type 1 diabetes and LADA can be challenging due to overlapping clinical presentations. Key distinguishing features include age of onset, presence of autoantibodies (e.g., GAD65, IA-2), and the rate of beta-cell decline. LADA typically occurs in adults over 30 years of age with a slower progression to insulin dependence compared to type 1 diabetes. Testing for autoantibodies is essential, though their absence does not rule out LADA. C-peptide levels can help assess residual beta-cell function. Clinicians should consider genetic predisposition and family history. While initial management of LADA may involve lifestyle modifications and oral antidiabetic agents, insulin therapy is often required eventually. Uncontrolled type 1 diabetes requires insulin from the outset. Consider implementing early insulin therapy in LADA if glycemic control is not achieved with other measures. Explore the use of genetic testing and C-peptide measurements for improved diagnostic accuracy.
Uncontrolled diabetes mellitus presents in this patient with persistent hyperglycemia despite previously prescribed diabetic management. The patient reports symptoms consistent with poorly controlled blood sugar, including polyuria, polydipsia, polyphagia, and unexplained weight loss. HbA1c levels are elevated above the target range, confirming the diagnosis of uncontrolled diabetes. Review of systems reveals ongoing fatigue and blurred vision. Assessment indicates potential complications related to uncontrolled diabetes, including diabetic neuropathy, nephropathy, and retinopathy risk. The patient's current medication regimen, including oral hypoglycemic agents or insulin therapy, is being reevaluated for efficacy and adherence. Lifestyle modifications such as diet, exercise, and blood glucose monitoring are being reinforced and intensified. Patient education regarding diabetes management, medication compliance, and potential long-term complications is provided. Referral to a certified diabetes educator and registered dietitian is initiated for comprehensive diabetes self-management training and nutritional guidance. Follow-up appointment is scheduled to monitor blood glucose control, assess treatment response, and address any emerging complications. Differential diagnoses considered include type 1 diabetes, type 2 diabetes, and secondary diabetes. ICD-10 codes E11.9 (type 2 diabetes mellitus without complications) or E10.9 (type 1 diabetes mellitus without complications), with an additional code for uncontrolled diabetes, and relevant Z codes for long-term use of medication are being considered based on further evaluation. This plan is consistent with evidence-based guidelines for diabetes management and aims to improve glycemic control and reduce the risk of long-term diabetic complications.