Coding For a Diabetic Pregnant Patient? It’s Easier Than You Think.

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Do you find coding for a diabetic pregnant patient intimidating? Read this post before you panic. Here I break down the guidelines and make things a little more digestible and a little less headache-inducing.

Diabetes is a condition characterized by high blood sugar. According to the CDC, more than 37 million adults in the United States have diabetes – that’s about 1-10.[1] So, there’s a pretty good chance that you’ll need to get nice and comfortable with the diabetes guidelines – hold their hand, buy them dinner, get to know them, be their creepy friend. Just kidding. But seriously – know your guidelines.

I would absolutely love to dive into the diabetes guidelines for you and dissect them like a tender Texas brisket, but for today I’m going to focus on something that is more of a nuance in medical coding – coding for diabetes in pregnancy.

There are two types of diabetes you’re going to encounter when coding for a pregnant diabetic patient:

Pre-existing diabetes
Gestational diabetes

Why is it important to know the difference between the two?

Not only are there different guidelines when reporting pre-existing and gestational diabetes, but some categories in Chapter 15 actually distinguish between conditions that existed before the pregnancy and conditions that are the direct result of the pregnancy.

Alright, let’s dive into a little more detail . . .

First, let’s talk a bit about pre-existing diabetes

What is pre-existing diabetes? Well, in this context, the term pre-existing just means that the patient had diabetes before the pregnancy. Pretty simple, right? No really, that wasn’t a trick question, it really is that simple. When a patient has pre-existing diabetes in pregnancy, they can either have type 1 or type 2 diabetes.

Let me elaborate a little on the types of diabetes . . .

What is Type 1 diabetes?

When someone has type 1 diabetes their pancreas doesn’t create enough insulin, and in some cases, it doesn’t create any at all. Why is insulin so important, you might ask? Because insulin regulates blood sugar levels. Insulin is the reason you can eat an entire pint of double chocolate chunky fudge ice cream on a Tuesday night in your underpants and feel nothing but shame.

I like to think of insulin like a key and the body’s cells like a locked door. This key lets blood sugar into the cells so it can do what blood sugar is supposed to do – be used as energy. But without insulin, blood sugar just kind of hangs around in your bloodstream and has nowhere to go. When too much blood sugar is in your bloodstream for too long, it can cause some serious health conditions, like heart disease, kidney disease, and vision loss.

And what about Type 2 diabetes?

Do you remember when I said that more than 37 million adults in the United States have diabetes? Well, approximately 90-95% of those 37 million people have type 2 diabetes.[2]

What is type 2 diabetes? When someone has type 2 diabetes their body’s cells don’t respond the way they should when they encounter insulin. The key doesn’t quite shimmy into the lock like it used to. When that happens, the pancreas creates more and more insulin to fix the issue, and eventually, your poor pancreas just can’t keep up. I mean, imagine chucking a ton of keys at a locked door and hoping one makes it into the keyhole. Sure, it might work, but I’m guessing not very well. When your pancreas can’t keep up, your blood sugar rises. And like I talked about when discussing type 1 diabetes, high blood sugar levels cause damage to the body and can lead to serious health conditions.

Let’s move on to how to code for pre-existing diabetes in pregnancy. . .

Category O24

Alright, let’s talk category O24 for a minute. Category O24 is used for patients with diabetes mellitus in pregnancy, childbirth, and the puerperium. Pre-existing type 1 diabetes in pregnancy, pre-existing type 2 diabetes in pregnancy, and gestational diabetes are all coded from this category.

When looking at your ICD-10-CM manual, you will notice that the subcategories for O24 are broken down to be pretty specific. Not only do the codes that fall under this category specify the type of diabetes and whether it was during pregnancy, childbirth, or the puerperium, but some of them actually specify the trimester.

Trimester?

For those of you who aren’t familiar with what week is considered what trimester, don’t worry, I got you. The first trimester is from week one to the end of week twelve. The second trimester is week thirteen through week twenty-eight, and the third trimester is week twenty-nine through week forty.

This might make it a little easier . . .

First trimester = Weeks 1-12
Second Trimester = Weeks 13-28
Third trimester = Weeks 29-40

Ok, but how do you code for pre-existing diabetes in pregnancy?

Well, unlike with gestational diabetes, there are at least two codes required when coding for pre-existing diabetes in pregnancy. The first code you want to select should come from that category O24 that we just talked about. After selecting a code from category O24 it should be followed by a code from code range E08-E13 to report the type of diabetes.[3] It is important that you document the type of diabetes because this is pre-existing diabetes and codes from category O24 do not specify the type of diabetes.

And what if pre-existing diabetes in pregnancy is controlled by medication?

Many pregnant patients with pre-existing diabetes control their condition through the use of insulin, oral medications, or diet. If medication is documented, it should be coded in addition to codes from categories O24 and E08-E13.[4]

Here are some examples of coding for a pregnant patient with pre-existing diabetes:

Controlled by insulin?