ICD Code E11.69

ICD code E11.69 is used to classify a diagnosis of Type 2 diabetes mellitus when it is accompanied by other specified complications. This code is part of the ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) system, which is used by healthcare providers to document and categorize medical conditions for billing and statistical purposes. The "E11" indicates Type 2 diabetes, while the ".69" specifies that there are additional complications associated with the condition that do not fall under more specific categories. This code helps ensure accurate documentation and appropriate reimbursement for the complexity of care required for patients with these additional health issues.

When using the ICD code for a specific condition, it is crucial to ensure that the diagnostic criteria and symptoms align with the code's intended use. For the condition associated with the code provided, consider the following diagnostic criteria and symptoms:

1. Diagnosis of Type 2 Diabetes Mellitus: Confirmed diagnosis of Type 2 diabetes, typically characterized by insulin resistance and relative insulin deficiency.

2. Presence of Complications: Identification of complications that are directly related to Type 2 diabetes but are not classified under more specific categories.

3. Exclusion of Other Specific Complications: Ensure that the complications do not fall under more specific ICD codes for diabetes-related complications such as nephropathy, retinopathy, or neuropathy.

4. Clinical Documentation: Comprehensive clinical documentation that specifies the nature of the complication and its direct association with Type 2 diabetes.

5. Symptomatology: Presence of symptoms that are indicative of the specified complication, which may include but are not limited to:

• Unexplained weight loss or gain
• Fatigue or lethargy
• Recurrent infections
• Delayed wound healing
• Any other symptom that can be clinically linked to the specified complication.

6. Laboratory and Diagnostic Tests: Results from laboratory tests or diagnostic procedures that support the presence of the specified complication, ensuring that they are consistent with the clinical presentation.

7. Exclusion of Type 1 Diabetes: Ensure that the patient does not have Type 1 diabetes, as the management and complications may differ.

8. Review of Patient History: Thorough review of the patient's medical history to rule out other potential causes for the symptoms and complications.

By adhering to these criteria, healthcare providers can ensure accurate coding, which is essential for effective healthcare revenue cycle management and optimal patient care.

For the ICD code E11.69, which pertains to Type 2 diabetes mellitus with other specified complication, the relevant CPT codes can vary based on the specific complications and treatments involved. However, some common CPT codes that might be applicable include:

1. 99201-99215: Evaluation and Management (E/M) codes for office or other outpatient visits, depending on the complexity and time spent with the patient.

2. 82947: Glucose; quantitative, blood (except reagent strip).

3. 83036: Hemoglobin; glycosylated (A1c).

4. 95250: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.

5. 95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.

6. 97802-97804: Medical nutrition therapy; initial assessment and intervention, individual or group.

7. G0108: Diabetes outpatient self-management training services, individual, per 30 minutes.

8. G0109: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes.

These codes are examples and may not cover all possible scenarios. The specific CPT codes used will depend on the individual patient's treatment plan and the healthcare provider's documentation. Always ensure coding is aligned with the latest guidelines and payer-specific requirements.

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