2024 ICD-10-CM Diagnosis Code E11.65
Type 2 diabetes mellitus with hyperglycemia
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Diabetic - poor control
- Hemoglobin A1C - diabetic control finding
- Hemoglobin A1c greater than 9% indicating poor diabetic control
- Hyperglycemia due to diabetes mellitus
- Hyperglycemia due to type 2 diabetes mellitus
- Hyperglycemic crisis due to diabetes mellitus
- Pregestational diabetes mellitus AND/OR impaired glucose tolerance, modified White class D
- Pregestational diabetes mellitus AND/OR impaired glucose tolerance, modified White class FR
- Severe hyperglycemia due to diabetes mellitus
|CCSR Category Code
|Inpatient Default CCSR
|Outpatient Default CCSR
|Diabetes mellitus with complication
|Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
|Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
|Diabetes mellitus, Type 2
|N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.
|N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.
The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system. As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for a particular encounter. Assign as many codes from categories E08 - E13 as needed to identify all of the associated conditions that the patient has.
If the type of diabetes mellitus is not documented in the medical record the default is E11.-, Type 2 diabetes mellitus.
Index to Diseases and Injuries References
The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).
Quality Payment Program Measures
When code E11.65 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
|Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
|Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
|Effective Clinical Care
|Claims, Electronic Health Record, Cms Web Interface, Registry
|Diabetes: Eye Exam
|Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period.
|Effective Clinical Care
|Claims, Electronic Health Record, Registry
Diabetes Type 2
What is type 2 diabetes?
Type 2 diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose is your main source of energy. It comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. If you have diabetes, your body doesn't make enough insulin or doesn't use insulin well. The glucose then stays in your blood and not enough goes into your cells.
Over time, having too much glucose in your blood can cause health problems. But you can take steps to manage your diabetes and try to prevent these health problems.
What causes type 2 diabetes?
Type 2 diabetes may be caused by a combination of factors:
- Being overweight or having obesity
- Not being physically active
- Genetics and family history
Type 2 diabetes usually starts with insulin resistance. This is a condition in which your cells don't respond normally to insulin. As a result, your body needs more insulin to help the glucose enter your cells. At first, your body makes more insulin to try to get cells to respond. But over time, your body can't make enough insulin, and your blood glucose levels rise.
Who is at risk for type 2 diabetes?
You are at higher risk of developing type 2 diabetes if you:
- Are over age 45. Children, teenagers, and younger adults can get type 2 diabetes, but it is more common in middle-aged and older people.
- Have prediabetes, which means that your blood sugar is higher than normal but not high enough to be called diabetes
- Had diabetes in pregnancy or gave birth to a baby weighing 9 pounds or more.
- Have a family history of diabetes
- Are overweight or have obesity
- Are Black or African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander
- Are not physically active
- Have other conditions such as high blood pressure, heart disease, stroke, polycystic ovary syndrome (PCOS), or depression
- Have low HDL (good) cholesterol and high triglycerides
- Have acanthosis nigricans - dark, thick, and velvety skin around your neck or armpits
What are the symptoms of type 2 diabetes?
Many people with type 2 diabetes have no symptoms at all. If you do have them, the symptoms develop slowly over several years. They might be so mild that you do not notice them. The symptoms can include:
- Increased thirst and urination
- Increased hunger
- Feeling tired
- Blurred vision
- Numbness or tingling in the feet or hands
- Sores that do not heal
- Unexplained weight loss
How is type 2 diabetes diagnosed?
Your health care provider will use blood tests to diagnose type 2 diabetes. The blood tests include:
- A1C test, which measures your average blood sugar level over the past 3 months
- Fasting plasma glucose (FPG) test, which measures your current blood sugar level. You need to fast (not eat or drink anything except water) for at least 8 hours before the test.
- Random plasma glucose (RPG) test, which measures your current blood sugar level. This test is used when you have diabetes symptoms and the provider does not want to wait for you to fast before having the test.
What are the treatments for type 2 diabetes?
Treatment for type 2 diabetes involves managing your blood sugar levels. Many people are able to do this by living a healthy lifestyle. Some people may also need to take medicine.:
- A healthy lifestyle includes following a healthy eating plan and getting regular physical activity. You need to learn how to balance what you eat and drink with physical activity and diabetes medicine, if you take any.
- Medicines for diabetes include oral medicines, insulin, and other injectable medicines. Over time, some people will need to take more than one type of medicine to control their diabetes.
- You will need to check your blood sugar regularly. Your health care provider will tell you how often you need to do it.
- It's also important to keep your blood pressure and cholesterol levels close to the targets your provider sets for you. Make sure to get your screening tests regularly.
Can type 2 diabetes be prevented?
You can take steps to help prevent or delay type 2 diabetes by losing weight if you are overweight, eating fewer calories, and being more physically active. If you have a condition which raises your risk for type 2 diabetes, managing that condition may lower your risk of getting type 2 diabetes.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
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What is blood glucose?
Blood glucose, or blood sugar, is the main sugar found in your blood. It is your body's primary source of energy. It comes from the food you eat. Your body breaks down most of that food into glucose and releases it into your bloodstream. When your blood glucose goes up, it signals your pancreas to release insulin. Insulin is a hormone that helps the glucose get into your cells to be used for energy.
For people with diabetes, your body doesn't make enough insulin, can't use it as well as it should, or both. Too much glucose stays in your blood and doesn't reach your cells.
What is hyperglycemia?
Hyperglycemia means high blood glucose. It most often affects people who have diabetes. When you have diabetes, your body doesn't make enough insulin or can't use it the right way. Too much glucose stays in your blood and doesn't reach your cells.
What causes hyperglycemia?
A key part of managing diabetes is controlling your blood glucose levels. To do this, you need to follow a diabetes meal plan and get regular physical activity. You might also need to take diabetes medicines. You have to balance all of these to keep your blood glucose at the right levels. But if you eat too much food or the wrong foods, don't take your medicines correctly, or don't get physical activity, you can get hyperglycemia. It can also happen if you are stressed or sick.
Less commonly, people who don't have diabetes can also get hyperglycemia. It can be caused by conditions that can affect insulin or glucose levels in your blood. They include problems with your pancreas or adrenal glands, certain medicines, and severe illnesses.
What are the symptoms of hyperglycemia?
The symptoms of hyperglycemia include:
- Feeling thirsty
- Feeling tired or weak
- Urinating (peeing) often
- Blurred vision
If you are diabetic and you often have high blood glucose levels or the symptoms of hyperglycemia, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or diabetes medicines.
If you don't have diabetes and you are having these symptoms, see your provider to find out the cause and how to treat it.
What other problems can hyperglycemia cause?
If hyperglycemia is not treated, it can cause other problems. In people with diabetes, long-term hyperglycemia can lead to serious health problems (diabetes complications).
If your blood glucose levels get very high, you can develop diabetes-related ketoacidosis (DKA). It happens when your body doesn't have enough insulin to allow blood glucose into your cells for use as energy. Instead, your liver breaks down fat for fuel. This process produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body. This can be life-threatening.
The symptoms of DKA may include:
- Trouble breathing
- Nausea or vomiting
- Pain in your abdomen (belly)
- Feeling very tired or sleepy
If you have an an at-home test for ketones, check your ketone level every 4 to 6 hours when your blood glucose is very high or when you are having these symptoms. If the test shows that your ketones are moderate or high, or if you don't have a ketones test, contact your health care provider right away or get emergency medical help.
How is hyperglycemia diagnosed?
If you have diabetes, you'll most likely need to check your blood glucose every day and make sure that it's not too high. You can do this with a blood glucose meter or continuous glucose monitoring (CGM) system.
There are also blood tests that providers can use to check if your blood glucose is too high.
What are the treatments for hyperglycemia?
If you have diabetes and often have high blood glucose, your health care team may make changes to your diabetes meal plan, physical activity plan, and/or diabetes medicines.
If you have severe hyperglycemia and are having symptoms of DKA, you will need treatment at the hospital. The treatment often includes I.V. (intravenous) fluids and insulin.
Can hyperglycemia be prevented?
If you have diabetes, managing your diabetes can help prevent hyperglycemia. To manage your diabetes, it's important to:
- Follow your diabetes meal plan
- Get regular physical activity
- If you need diabetes medicines, take them correctly
- Regularly check your blood glucose level
- Get regular checkups with your health care team
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Type 2 diabetes
Type 2 diabetes is a disorder characterized by abnormally high levels of blood glucose, also called blood sugar. In this form of diabetes, the body stops using and making insulin properly. Insulin is a hormone produced in the pancreas that helps regulate blood glucose levels. Specifically, insulin controls how much glucose (a type of sugar) is passed from the blood into cells, where it is used as an energy source. When blood glucose levels are high (such as after a meal), the pancreas releases insulin to move the excess glucose into cells, which reduces the amount of glucose in the blood.
Most people who develop type 2 diabetes first have insulin resistance, a condition in which the body's cells use insulin less efficiently than normal. As insulin resistance develops, more and more insulin is needed to keep blood glucose levels in the normal range. To keep up with the increasing need, insulin-producing cells in the pancreas (called beta cells) make larger amounts of insulin. Over time, the beta cells become less able to respond to blood glucose changes, leading to an insulin shortage that prevents the body from reducing blood glucose levels effectively. Most people have some insulin resistance as they age, but inadequate exercise and excessive weight gain make it worse, greatly increasing the likelihood of developing type 2 diabetes.
Type 2 diabetes can occur at any age, but it most commonly begins in middle age or later. Signs and symptoms develop slowly over years. They include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet (diabetic neuropathy), sores that do not heal well, and weight loss. If blood glucose levels are not controlled through medication or diet, type 2 diabetes can cause long-lasting (chronic) health problems including heart disease and stroke; nerve damage; and damage to the kidneys, eyes, and other parts of the body.
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- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.
 Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:
- The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
- The condition places limitations on self-care, independent living, and social interactions.