Diabetes Prevention from a Coding Perspective by Traci Vela

According to the CDC (Centers for Disease Control and Prevention), more than a million Americans are given a diagnosis of adult-onset diabetes each year, and thousands of children are born with the illness. This same study marks diabetes as the seventh-leading cause of death in our nation currently, which is a scary statistic that highlights the rampage of the disease. However, in some cases, diabetes can be prevented and occasionally cured if the right steps are taken. More doctors each year are working hard to ensure that not only Americans are less likely to develop diabetes, but that more are also aware of the many options for prevention.


Early Codes for Diabetic Screening/Symptoms

Diabetes mellitus screening (a screening that deals with finding out why/if a patient is processing sugar correctly in the body) is usually a first step when a patient has a family history or environmental factors that indicate predisposition to diabetes (type 2 especially). This presents a unique set of codes from other diabetes-related codes, so the attending physician is reimbursed for the screening. As of October 2017, the appropriate ICD-10 code is Z13.1: Encounter for screening for diabetes mellitus[1], which is exempt from POA (present on admission) reporting, with the following back-references:

  • Z00-Z99: Factors influencing health status and contact with health services
  • Z00-Z13: Persons encountering health services for examinations
  • Z13: Encounter for screening for other diseases and disorders

Don’t forget to note that Z13.1 is part of the larger Diagnostics Related Group 951: Other factors influencing health status.


Diagnosing and Coding Prediabetes

From a medical perspective, someone can have markers of Type 2 diabetes without receiving this diagnosis. These patients are known as “prediabetic”, which is a general term for someone who doesn’t process sugar correctly,, according to the Mayo Clinic.[2] However, these patients may have no other symptoms, all Type 2 diabetes symptoms, or some level of symptoms in between. These symptoms may include, but are not limited to, the following:

  • Dark patches on the skin
  • Low energy
  • Frequent need to urinate
  • Increased/Abnormal thirstiness
  • Family history/Increased environmental risk of diabetes
  • History of gestational diabetes (female only)[3]

From a coding perspective, the right ICD-10 code to use in this case is R73.03 as of October, 2017. This ensures that providing physician can be reimbursed for services rendered to/for patients who are diagnosed as prediabetic. The codes above R73.03 include explanation back-references that are typically applicable to this code[4]:

  • R00-R99: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
  • R70-R79: Abnormal findings on examination of blood, without diagnosis
  • R73: Elevated blood glucose level
  • R73.0: Abnormal glucose

When researching the Diagnosis Index, back-reference the following as well:


When in Doubt, Search

A diagnosis of prediabetes is not necessarily an indication that a patient will be diagnosed with type 2 diabetes. However, a person with prediabetes is at a higher risk for development of type 2 diabetes, so please keep this in mind when coding.  After all, with exercise, diet and similar lifestyle changes, a patient may no longer need treatment for prediabetic disposition. Treatment for prediabetes often includes eating a healthy diet, losing 5-10 percent of current body weight, exercising a minimum of thirty minutes for five days each week, and similar regimen.

When in doubt though, make sure to review all appropriate back-references, reimbursement claims, current diagnoses, and reference the Diagnosis Index with questions. Also, check for updates, changes, modifications, new inclusions/exclusions, etc.

[1] http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z00-Z13/Z13-/Z13.1

[2] https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278

[3] https://diabetic.news/13-early-signs-symptoms-prediabetes/13/

[4] http://www.icd10data.com/ICD10CM/Codes/R00-R99/R70-R79/R73-/R73.03