Metabolic Complications of Diabetes Mellitus
Becky Buegel, RHIA, CDIP, CHP November 18, 2021 Outpatient Coding Leave a Comment
Diabetes mellitus (DM) Types 1 and 2 are both known to be associated with a variety of complications. Some complications, like kidney disease or ophthalmic problems are, more often than not, related to poorly controlled diabetes.
Acute metabolic complications are one of the many different types of complications that can develop in patients with diabetes. These complications can often be life-threatening.
Let’s take a look at the metabolic derangements (or abnormalities, if you will) and which ICD-10-CM codes would be assigned to these complications.
DKA is one type of metabolic acidosis that can develop when too much acid is produced by the body. It is a common, and unfortunately life-threatening complication of Type 1 diabetes. It is especially prevalent when the DM is first diagnosed. DKA is less prevalent in Type 2 DM.
DKA develops when the body doesn’t have enough insulin to use as energy. The liver starts to break down fat for fuel, which produces acids called ketones. DKA occurs when too many ketones are produced too quickly, thus building up to dangerous levels in the body. Blood sugars (glucose) are usually in the range of 250-300 gm/dl over several hours.
Lactic Acidosis (LA)
Lactic acidosis is another type of metabolic acidosis that can occur as a diabetic complication. This type of metabolic acidosis has a high anion gap characterized by serum lactate levels >5 mmol/L (4 mEq/L). What this means, in more understandable terms, is that lactic acid accumulates in the bloodstream. Though it is not considered a “disease-specific” complication of DM, it can be caused by precipitating factors including (but not limited to) such as shock, and the use of metformin.
Though it can develop in Type 1 patients, especially those with advanced microangiopathy, LA is seen more often in Type 2 diabetics, especially those with conditions (such as renal insufficiency/failure) that can cause accumulation of medication in the body, and/or decreased lactate clearance, which can be caused by liver impairment, for example.
This condition is an avoidable, though potentially life-threatening complication of DM that is due to insufficient amounts of insulin in the body. HHS is diagnosed when blood sugar levels are over 600 mg/dl; traces of ketones may be found, however it’s more likely that there are no ketones present.
Simply put, hypoglycemia in a diabetic patient means there’s not enough glucose in their blood. Since glucose is the main source of fuel for the body and brain, the patient will not function well if the glucose levels are too low. Hypoglycemia is defined as having a blood sugar level below 70 mg/dl. Immediate treatment is required when blood sugar levels fall too low, as they’ll continue to fall unless treated.
Hypoglycemia is the most common, potentially life-threatening acute complication of DM and can be caused by multiple factors, including missed meals and inadvertent insulin dosing errors – meaning too much is administered.
Treating Metabolic Complications
Treating three out of four of these metabolic complications of DM involves lowering blood sugars to acceptable ranges. How this is accomplished isn’t as important as making certain therapy is initiated quickly. Hypoglycemia treatment is designed for rapid escalation of blood sugars to what would be considered normal/acceptable for a diabetic patient. Continuous maintenance of acceptable blood sugar levels is the ultimate goal in all instances. Better control equals better health.
Coding Clinic – 2Q – 2016 – pg. 10 – Diabetic Ketoacidosis Not Further Specified
Coding Clinic – 4Q 0 2017 – pg. 6 – Diabetic Ketoacidosis
Coding Metabolic Complications of Diabetes Mellitus
Diabetic Ketoacidosis With Coma
E08.11 – DM due to underlying condition with ketoacidosis with coma
E09.11 – Drug or chemical induced DM with ketoacidosis with coma
E10.11 – Type 1 DM with ketoacidosis with coma
E13.11 – Other specified DM with ketoacidosis with coma
Diabetic Ketoacidosis Without Coma
E08.10 – DM due to underlying condition with ketoacidosis without coma
E09.10 – Drug or chemical induced DM with ketoacidosis without coma
E10.10 – Type 1 DM with ketoacidosis without coma
E13.10 – Other specified DM with ketoacidosis without coma
Diabetic Lactic Acidosis With Coma
Diabetic Lactic Acidosis Without Coma
Diabetic Hyperosmolarity With Coma
E08.01 – DM due to underlying condition with hyperosmolarity with NKHHC*
E09.01 – Drug or chemical induced DM with hyperosmolarity with NKHHC*
E11.01 – Type 2 DM with hyperosmolarity with NKHHC*
E13.01 – Other specified DM with hyperosmolarity with NKHHC*
Diabetic Hyperosmolarity Without Coma
E08.00 – DM due to underlying condition with hyperosmolarity without NKHHC*
E09.00 – Drug or chemical induced DM with hyperosmolarity without NKHHC*
E11.00 – Type 2 DM with hyperosmolarity without NKHHC*
E13.00 – Other specified DM with hyperosmolarity without NKHHD*
Diabetic Hypoglycemia With Coma
E08.641 – DM due to underlying condition with hypoglycemia with coma
E09.641 – Drug or chemical induced DM with hypoglycemia with coma
E10.641 – Type 1 DM with hypoglycemia with coma
E13.641 – Other specified DM with hypoglycemia with coma
Diabetic Hypoglycemia Without Coma
E08.649 – DM due to underlying condition with hypoglycemia without coma
E09.649 – DM due to underlying condition without coma
E10.649 – Type 2 DM with hypoglycemia without coma
E13.649 – Other specified DM with hypoglycemia without coma
* NKHHC – Nonketotic hyperglycemic hyperosmolar coma
There are numerous types of complications that a patient can develop as a result of having diabetes mellitus (DM). Metabolic complications can develop from lack of insulin or overuse of insulin. No matter the cause, metabolic complications can be life-threatening. This blog classifies four metabolic complications of DM and outlines proper ICD-10-CM code assignment.
https://www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html#:~:text=Diabetic%20ketoacidosis%20(DKA)%20is%20a,cells%20for%20use%20as%20energy.
https://empendium.com/mcmtextbook/chapter/B31.II.13.3.3.
AHA’s ICD-10-CM and ICD-10-PCS Coding Handbook © 2021