The ICD-10-CM Diagnosis Code E11.65 is a specific and billable code used in the United States to classify Type 2 diabetes mellitus with hyperglycemia. This code is crucial for medical billing, record-keeping, and epidemiological tracking of diabetes-related conditions. Effective since October 1, 2015, and updated annually, E11.65 ensures that healthcare providers can accurately document and classify cases of type 2 diabetes where hyperglycemia is a significant factor.
Understanding E11.65: Type 2 Diabetes with Hyperglycemia
Hyperglycemia, commonly known as high blood sugar, is a condition where the glucose level in the blood is elevated. In the context of Type 2 diabetes, hyperglycemia occurs when the body does not produce enough insulin or does not effectively use the insulin it produces to regulate blood sugar levels. This leads to a buildup of glucose in the bloodstream, which can cause a range of symptoms and long-term health complications if not properly managed.
Symptoms and Clinical Significance
Recognizing hyperglycemia is vital for effective diabetes management. Common symptoms associated with high blood sugar include:
- Increased thirst
- Frequent urination
- Blurred vision
- Fatigue
- Headache
Persistent hyperglycemia, as indicated by the diagnosis code E11.65, can lead to serious health issues over time, such as nerve damage (neuropathy), kidney damage (nephropathy), eye damage (retinopathy), and cardiovascular diseases. Therefore, accurate diagnosis and coding with E11.65 are essential for initiating appropriate treatment plans and monitoring patient health.
Coding and Reimbursement
E11.65 is a billable/specific code, meaning it is recognized by insurance companies and healthcare systems for reimbursement purposes. The specificity of this code allows for precise tracking of cases of Type 2 diabetes complicated by hyperglycemia. This is important for:
- Accurate billing: Ensuring healthcare providers are properly reimbursed for the care provided to patients with this specific condition.
- Data analysis: Allowing for the collection of statistical data on the prevalence and management of hyperglycemia in Type 2 diabetes populations.
- Healthcare planning: Informing public health initiatives and resource allocation for diabetes care.
Synonyms and Related Terms
While E11.65 is the official ICD-10-CM code, it may be referred to using different terms in clinical practice. Approximate synonyms for E11.65 include:
- Diabetes type 2 with hyperglycemia
- Hyperglycemia due to type 2 diabetes mellitus
Code History and Updates
The code E11.65 was introduced in the 2016 ICD-10-CM code set and has been consistently updated annually to maintain its relevance and accuracy within the evolving landscape of medical coding. As of the 2025 edition, which became effective on October 1, 2024, there have been no significant changes to the code description or its application. This stability ensures consistent usage and data tracking over time.
Related ICD-10-CM Codes
Understanding related codes can provide further context. Codes adjacent to E11.65 in the ICD-10-CM manual include other complications of Type 2 diabetes, such as:
- E11.64: Type 2 diabetes mellitus with hypoglycemia (the opposite condition of hyperglycemia)
- E11.62: Type 2 diabetes mellitus with skin complications
- E11.63: Type 2 diabetes mellitus with oral complications
- E11.69: Type 2 diabetes mellitus with other specified complication
These related codes highlight the range of complications that can arise from Type 2 diabetes, emphasizing the importance of detailed and accurate diagnosis coding.
Conclusion
In summary, ICD-10-CM code E11.65 is a critical tool for classifying and documenting cases of Type 2 diabetes mellitus with hyperglycemia. Its specific nature ensures accurate medical billing, facilitates data analysis, and supports effective healthcare management for patients experiencing high blood sugar as a complication of their diabetes. For healthcare professionals, understanding and correctly applying E11.65 is essential for providing quality care and maintaining accurate medical records.
