CodingIntel members can download our guide to Risk adjusted diagnosis coding for medical practices for more explanation and examples. This article is specific to diabetes.
9.4% of Americans have diabetes, and in some states, the incidence of diabetes reaches almost 15%. Medical practices in ACOs or with commercial risk contracts can provide the payer with an accurate picture of their patients’ disease burden and health status through diagnosis coding on claims forms. Since diabetes is so prevalent, this is a good place to start.
HCC coding for Diabetes
HCC 17 Diabetes with acute complications RAF 0.302[1]
HCC 18 Diabetes with chronic complications RAF 0.302
HCC 19 Diabetes without complications RAF 0.105
- ICD-10 codes for diabetes with complications carry a RAF three times higher than E11.9, diabetes uncomplicated
- Although the words “controlled” and “uncontrolled” appear in many EMR definitions of diabetes, the ICD-10 definitions are not defined with those words
- Although conditions in the same category count only once, most groups want to capture all of the diabetic complications in the patient’s problem list
- If a patient had a diabetic complication, use it instead of code E11.9
- For E11.69, diabetes with other specified complication, add a code for that additional complication
- For some conditions (see below) add a code for the specific type of disease (CAD, for example) or for the state or severity
FOR diabetes (type 2) | USE | NOTES |
with hyperlipidemia |
E11.69 DM with other specified complication |
Add code for hyperlipemia; document link to condition |
with nephropathy |
E11.21 DM with nephropathy |
|
with cataract |
E11.36 DM with cataract |
|
with neuropathy |
E11.40–E11.49 |
|
with non-proliferative retinopathy |
E11.319 DM with non-proliferative retinopathy |
|
with other circulatory conditions |
E11.59 DM with other circulatory conditions |
Add code for specific complication, CAD; document link to condition |
with hyperglycemia |
E11.65 DM with hyperglycemia |
|
with CKD |
E11.22 DM with CKD |
Add code for stage of CKD |
with PAD/PVD |
E11.51 DM with PAD/PVD |
|
with foot ulcer |
E11.621 DM with foot ulcer |
Add code for location and stage of ulcer, L97.- |
with other skin ulcer |
E11.622 DM with other skin ulcer |
Add code for location and stage of ulcer, L97.- |
[1] All of the values in this guide use the coefficient for a person living in the community, non-dual eligible for Medicare and Medicaid, aged.
Additional resources
The Diagnosis coding section of CodingIntel includes additional resources for HCC and ICD-10 coding.
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