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E11.9
ICD-10-CM
Unspecified Diabetes Mellitus

Learn about Unspecified Diabetes Mellitus, including clinical documentation requirements, ICD-10 code E149, and correct medical coding guidelines. This resource provides information for healthcare professionals on diagnosing and documenting diabetes with unspecified type, covering differential diagnosis, lab tests, and best practices for accurate medical records. Find guidance on diabetes mellitus unspecified type management and proper coding for optimal reimbursement.

Also known as

Diabetes Mellitus Unspecified
DM Unspecified
diabetes nos

Diagnosis Snapshot

Key Facts
  • Definition : A form of diabetes where the specific type (1, 2, etc.) is not yet determined.
  • Clinical Signs : High blood sugar, frequent urination, excessive thirst, unexplained weight loss, blurred vision.
  • Common Settings : Primary care, endocrinology, diabetes education programs.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC E11.9 Coding
E10-E14

Diabetes mellitus

Covers all forms of diabetes mellitus without complications.

R73

Hyperglycemia

Elevated blood sugar, often related to uncontrolled diabetes.

E08-E13

Diabetes mellitus due to

Diabetes caused by underlying conditions or disorders.

Code-Specific Guidance

Decision Tree for

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

Is the type of diabetes known (Type 1, Type 2, etc.)?

  • Yes

    Do NOT code as unspecified. Code the specific type of diabetes.

  • No

    Is it documented as gestational diabetes?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Unspecified Diabetes
Type 2 Diabetes
Other Specified Diabetes Mellitus

Documentation Best Practices

Documentation Checklist
  • Diabetes Mellitus unspecified type documented
  • Hyperglycemia or hypoglycemia noted
  • No specific type of DM documented
  • Rule out other DM types (Type 1, Type 2, gestational)
  • Lab results supporting DM diagnosis present

Coding and Audit Risks

Common Risks
  • Unspecified Type Risk

    Coding E14.9 lacks specificity, impacting data accuracy for diabetes management, research, and reimbursement. CDI should clarify type.

  • Unconfirmed Diagnosis

    Using E14.9 without documented diagnostic criteria risks inaccurate coding. Audits may flag this as unsupported diagnosis.

  • Missed Secondary Codes

    Unspecified diabetes may have complications (e.g., neuropathy) requiring specific codes. Missing these impacts risk adjustment and care planning.

Mitigation Tips

Best Practices
  • Document complete patient history for specific DM type.
  • Improve HbA1c, fasting glucose, and random glucose documentation.
  • Query physician for clarification to specify DM type.
  • Code E14.9 only when DM type is truly unknown.
  • Review medical history for clues to underlying DM.

Clinical Decision Support

Checklist
  • Confirm hyperglycemia criteria met (A1C, FPG, OGTT)
  • R/O type 1, type 2, gestational, other specific types
  • Document reason for unspecified diagnosis
  • Review medication list for potential diabetes meds
  • Query physician if further clarification needed

Reimbursement and Quality Metrics

Impact Summary
  • Reimbursement Impact Summary: Unspecified Diabetes Mellitus (E149)
  • ICD-10-CM E149 coding accuracy impacts payer reimbursement.
  • Diabetes mellitus coding specificity affects quality reporting metrics.
  • Unspecified diabetes diagnosis may trigger medical record audits.
  • E149 use impacts HCC risk adjustment and potential underpayment.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Query DM etiology if unclear
  • R/O Type 1, Type 2 DM
  • Document supporting tests
  • Code E14.9 for unspecified DM
  • Check for gestational onset

Documentation Templates

Patient presents with signs and symptoms suggestive of diabetes mellitus, but the specific type (type 1, type 2, or other specific types) cannot be definitively determined at this time.  Presenting complaints include polyuria, polydipsia, and unexplained weight loss.  Fasting blood glucose levels are elevated, confirming hyperglycemia.  However, further diagnostic testing, such as HbA1c, C-peptide levels, and autoantibody tests, is required to differentiate between type 1 and type 2 diabetes mellitus or other specific types.  The patient denies any family history of diabetes.  Review of systems is otherwise unremarkable.  Assessment: Unspecified Diabetes Mellitus (ICD-10-CM code E14.9).  Plan:  Order HbA1c, C-peptide, and autoantibody panel.  Initiate lifestyle modifications including dietary counseling focused on carbohydrate control and a moderate exercise program.  Patient education provided regarding diabetes management, including blood glucose monitoring and potential medication needs.  Follow-up appointment scheduled in two weeks to review lab results and determine appropriate diabetes management strategy.  Differential diagnosis includes type 1 diabetes, type 2 diabetes, gestational diabetes (if applicable), and other specific types of diabetes.  Medical billing codes will be finalized upon confirmation of the specific diabetes type.