In ICD-10-CM, chapter 4, "Endocrine, nutritional and metabolic diseases (E00-E89)," includes a separate subchapter (block), Diabetes mellitus E08-E13, with the categories:
What you can do
There is also the fact that the dangers of diabetes mellitus are much greater than diabetes insipidus. Type I and Type II diabetes can cause severe, immediate symptoms that require immediate treatment. Lifestyle habits can even increase insulin absorption, such as taking a hot shower, which can create its own set of problems after a meal.
E11. 52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene.
A: The coder would report ICD-10-CM code I96 (gangrene, not elsewhere classified) as the principal diagnosis because of the “code first” note under code category L89. - (pressure ulcer).
Diabetic peripheral angiopathy (DPA) is a blood vessel disease caused by high blood sugar levels (glucose). It is one of the most common complications of diabetes. It affects blood vessels that carry oxygen-rich blood away from the heart. These vessels supply blood to many different parts of the body.
When you look up the condition “diabetes” in the Alphabetic Index, you will find directly underneath the main bolded term of diabetes the word “with.” When continuing down the page, you will find code E11. 621, Foot ulcer, and directly beneath that, code E11. 52, Gangrene.
People with diabetes may unknowingly develop wet gangrene after experiencing a minor toe or foot injury. Blood flow to the extremities is generally diminished in people with diabetes. This means that the tissue in these areas is unable to heal as quickly. As a result, infection can develop more easily.
ICD-10-CM Code for Type 2 diabetes mellitus with foot ulcer E11. 621.
Peripheral artery disease (PAD) is often used interchangeably with the term “peripheral vascular disease (PVD).” The term “PAD” is recommended to describe this condition because it includes venous in addition to arterial disorders.
PAD and CVI are both vascular diseases that prevent healthy blood flow. It can be easy to mix them up because they share some common aspects, but they also differ in many ways. Both PAD and CVI have symptoms that cause problems in your legs.
Medical Definition of angiopathy : a disease of the blood or lymph vessels.
Gangrene, not elsewhere classified I96 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM I96 became effective on October 1, 2021.
Gangrene is dead tissue (necrosis) consequent to ischemia. In the image above, we can see a black area on half of the big toe in a diabetic patient. This black area represents necrosis—dead tissue—in fact, gangrene of the big toe.
621, E13. 622).” Of these options, the most commonly used codes for diabetic foot ulcer are E10. 621 (Type 1 diabetes mellitus with foot ulcer) and E11. 621 (Type 2 diabetes mellitus with foot ulcer).
Icd-10 Diagnosis Code E11.52. Diabetes means your blood glucose, or blood sugar, levels are too high. With type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy.
The body system (s) affected 3. The complications affecting the body system (s) When coding diabetes mellitus, you should use as many codes from categories E08-E13* as necessary to describe all of the complications and associated conditions of the disease.
Example: Diabetes with heel ulcer of the right foot, fat layer exposed, would be coded E11.621 and L97.412. Note the additional code for the ulcer and the increase in specificity with this diagnosis.
Secondary diabetes is diabetes or glucose intolerance that develops from disorders or conditions other than type 1 or type 2 diabetes or gestational diabetes.
The ICD-10 “grace period” that the Centers for Medicare and Medicaid Services (CMS) granted us ended on October 1, 2016. It is now more important than ever to ensure you are coding to the highest specificity and following all ICD-10 guidelines.
Unspecified codes are still present in ICD-10, however, it is best practice to document, and ultimately code, to the highest specificity. Documenting only “diabetes with renal manifestations” or “diabetes with neurologic manifestations”, etc. does not best support documenting diabetic complications, is not complete documentation, ...
Diabetic coding in ICD-10 has changed significantly from ICD-9. The requirement for documenting the type of diabetes and linking it to any complications still exist. However, in ICD-10, there are very few diabetic codes that require an additional code for the manifestation. Those that do require an additional code are diabetes with CKD ...
I96 has an Excludes 2 for gangrene in diabetes mellitus, and the Alphabetic Index instructs us that Type 2 diabetes “with gangrene” goes to E11.52, according to the assumptive rule. The coding guidelines remind us of the “basic rule of coding…that further research must be done when the title of the code suggested by the Alphabetic Index clearly ...
There is an obvious clinical relationship. Peripheral vascular disease and peripheral neuropathy, also more common in diabetes, contribute to the development and severity of ulcers and gangrene.
However, I strongly object to the characterization that the “gangrene is associated with the pressure ulcer rather than the diabetes mellitus.”. Gangrene has to affect a body part (e.g., musculoskeletal system, intestine portion, gallbladder, etc.); it does not occur diffusely, i.e., directly due to diabetes.
For gestational diabetes (diabetes that occurs during pregnancy) women should be assigned a code under the 024.4 subheading and not any other codes under the 024 category.
If the type of diabetes that the patient has is not documented in the medical record, E11 codes for type 2 diabetes should be used as a default. If the medical record doesn’t say what type of diabetes the patient has but indicates that the patient uses insulin, the Type 2 diabetes codes should also be used.
The “unspecified” codes can be used when not enough information is known to give a more specific diagnosis; in that case, “unspecified” is technically more accurate than a more specific but as yet unconfirmed diagnosis. For more guidelines on using ICD-10 codes for diabetes mellitus, you can consult this document.