Diabetes ICD-10 Codes 2026Complete E08-E13 Reference Guide
Comprehensive ICD-10-CM reference for all diabetes mellitus codes. Type 2 (E11), type 1 (E10), gestational (O24.4), and secondary diabetes with complications coding, documentation requirements, and clinical examples for accurate billing.
Diabetes ICD-10 Code Categories Overview
The ICD-10-CM organizes diabetes mellitus codes into categories E08 through E13, plus O24.4 for gestational diabetes. Each category captures a specific etiology. The most commonly used category is E11 (type 2 diabetes), which accounts for approximately 90-95% of all diabetes diagnoses in the United States according to the CDC.
Diabetes mellitus due to underlying condition
Used when diabetes is caused by another disease such as cystic fibrosis, Cushing syndrome, or chronic pancreatitis. Code the underlying condition first.
Drug or chemical induced diabetes mellitus
For diabetes caused by medications such as corticosteroids, antipsychotics, or immunosuppressants. Use additional external cause code (T36-T65) to identify the drug.
Type 1 diabetes mellitus
Autoimmune destruction of beta cells. Formerly called insulin-dependent or juvenile-onset diabetes. Patient requires exogenous insulin for survival.
Type 2 diabetes mellitus
Insulin resistance and relative insulin deficiency. The most common form of diabetes. Default code category when type is not documented.
Other specified diabetes mellitus
Used for diabetes that does not fit other categories, such as post-pancreatectomy diabetes, secondary diabetes NEC, or certain genetic defects (MODY).
Gestational diabetes mellitus
Diabetes first recognized during pregnancy. Does not include pre-existing type 1 or type 2 diabetes in pregnancy (O24.0, O24.1).
Important: Default Coding Rule
If the type of diabetes is not documented in the medical record, the default is type 2 diabetes (E11). Per ICD-10-CM Official Guidelines Section I.C.4.a.2, when the documentation does not specify the type, assign a code from category E11. Always query the provider when the type is unclear for accurate coding.
Type 2 Diabetes Mellitus (E11) Codes
Category E11 is the most frequently used diabetes code category. These combination codes capture both the diabetes diagnosis and its associated complications in a single code. Below is a comprehensive reference for the most commonly used E11 codes with clinical use cases.
| Code | Description | Common Use Case |
|---|---|---|
| E11.9 | Type 2 DM without complications | Well-controlled diabetes on oral meds, no documented complications |
| E11.65 | Type 2 DM with hyperglycemia | Uncontrolled/poorly controlled diabetes with elevated blood glucose |
| E11.00 | Type 2 DM with hyperosmolarity without NKHHC | Hyperosmolar state without nonketotic hyperglycemic-hyperosmolar coma |
| E11.01 | Type 2 DM with hyperosmolarity with coma | Hyperosmolar hyperglycemic state (HHS) with coma |
| E11.10 | Type 2 DM with ketoacidosis without coma | DKA in type 2 diabetes, conscious patient |
| E11.11 | Type 2 DM with ketoacidosis with coma | DKA in type 2 diabetes with altered consciousness |
| E11.21 | Type 2 DM with diabetic nephropathy | Documented diabetic kidney disease / diabetic nephropathy |
| E11.22 | Type 2 DM with diabetic chronic kidney disease | Diabetic CKD; also assign N18.x for CKD stage |
| E11.29 | Type 2 DM with other diabetic kidney complication | Renal tubular degeneration or other renal manifestations |
| E11.311 | Type 2 DM with unspecified diabetic retinopathy with macular edema | Diabetic retinopathy with macular involvement, type unspecified |
| E11.319 | Type 2 DM with unspecified diabetic retinopathy without macular edema | Diabetic retinopathy without macular edema |
| E11.321 | Type 2 DM with mild nonproliferative retinopathy with macular edema | Mild NPDR with macular edema on dilated eye exam |
| E11.329 | Type 2 DM with mild nonproliferative retinopathy without macular edema | Mild NPDR without macular edema |
| E11.331 | Type 2 DM with moderate nonproliferative retinopathy with macular edema | Moderate NPDR with macular edema |
| E11.339 | Type 2 DM with moderate nonproliferative retinopathy without macular edema | Moderate NPDR without macular edema |
| E11.341 | Type 2 DM with severe nonproliferative retinopathy with macular edema | Severe NPDR with macular edema |
| E11.349 | Type 2 DM with severe nonproliferative retinopathy without macular edema | Severe NPDR without macular edema |
| E11.351 | Type 2 DM with proliferative diabetic retinopathy with macular edema | PDR with macular edema, often requiring laser or injection |
| E11.359 | Type 2 DM with proliferative diabetic retinopathy without macular edema | PDR without macular edema |
| E11.36 | Type 2 DM with diabetic cataract | Cataract attributed to diabetes |
| E11.40 | Type 2 DM with diabetic neuropathy, unspecified | Diabetic neuropathy NOS when specific type not documented |
| E11.41 | Type 2 DM with diabetic mononeuropathy | Single nerve involvement (e.g., cranial nerve palsy, carpal tunnel) |
| E11.42 | Type 2 DM with diabetic polyneuropathy | Distal symmetric polyneuropathy, the most common form |
| E11.43 | Type 2 DM with diabetic autonomic (poly)neuropathy | Gastroparesis, orthostatic hypotension, bladder dysfunction |
| E11.44 | Type 2 DM with diabetic amyotrophy | Proximal motor neuropathy with muscle weakness and wasting |
| E11.51 | Type 2 DM with diabetic peripheral angiopathy without gangrene | Peripheral vascular disease from diabetes without gangrene |
| E11.52 | Type 2 DM with diabetic peripheral angiopathy with gangrene | Diabetic peripheral vascular disease with gangrene |
| E11.59 | Type 2 DM with other circulatory complications | Other vascular manifestations of diabetes |
| E11.610 | Type 2 DM with diabetic neuropathic arthropathy | Charcot joint due to diabetes |
| E11.618 | Type 2 DM with other diabetic arthropathy | Other joint manifestations of diabetes |
| E11.620 | Type 2 DM with diabetic dermatitis | Necrobiosis lipoidica diabeticorum, diabetic dermopathy |
| E11.621 | Type 2 DM with foot ulcer | Diabetic foot ulcer; also code site from L97.x |
| E11.622 | Type 2 DM with other skin ulcer | Non-foot skin ulceration; also code site from L97-L98 |
| E11.628 | Type 2 DM with other skin complications | Other diabetic skin manifestations |
| E11.630 | Type 2 DM with periodontal disease | Periodontal disease attributed to diabetes |
| E11.638 | Type 2 DM with other oral complications | Other oral manifestations of diabetes |
| E11.641 | Type 2 DM with hypoglycemia with coma | Insulin reaction or drug-induced hypoglycemia with coma |
| E11.649 | Type 2 DM with hypoglycemia without coma | Hypoglycemic episode without loss of consciousness |
| E11.69 | Type 2 DM with other specified complication | Complications not elsewhere classified (e.g., osteomyelitis) |
| E11.8 | Type 2 DM with unspecified complications | When complications are documented but type is not specified |
Clinical Example: Type 2 Diabetes with Multiple Complications
A 62-year-old patient presents with type 2 diabetes, diabetic polyneuropathy in both feet, stage 3 CKD, and a non-healing foot ulcer on the right heel. The patient takes metformin and insulin glargine.
Type 1 Diabetes Mellitus (E10) Codes
Type 1 diabetes mellitus results from autoimmune destruction of pancreatic beta cells. The E10 category mirrors the E11 structure for complications coding. Because insulin use is inherent to type 1 diabetes, do not assign Z79.4 (long term insulin use) for these patients.
| Code | Description | Common Use Case |
|---|---|---|
| E10.9 | Type 1 DM without complications | Well-controlled type 1 diabetes without documented complications |
| E10.65 | Type 1 DM with hyperglycemia | Uncontrolled type 1 diabetes with elevated blood glucose |
| E10.10 | Type 1 DM with ketoacidosis without coma | DKA in type 1 diabetes, patient is conscious |
| E10.11 | Type 1 DM with ketoacidosis with coma | DKA with altered mental status or loss of consciousness |
| E10.21 | Type 1 DM with diabetic nephropathy | Documented diabetic kidney disease in type 1 |
| E10.22 | Type 1 DM with diabetic chronic kidney disease | Diabetic CKD; assign N18.x for CKD stage |
| E10.29 | Type 1 DM with other diabetic kidney complication | Other renal manifestations of type 1 diabetes |
| E10.311 | Type 1 DM with unspecified diabetic retinopathy with macular edema | Retinopathy type unspecified, with macular edema |
| E10.319 | Type 1 DM with unspecified diabetic retinopathy without macular edema | Retinopathy type unspecified, no macular edema |
| E10.321 | Type 1 DM with mild NPDR with macular edema | Mild nonproliferative diabetic retinopathy with macular edema |
| E10.329 | Type 1 DM with mild NPDR without macular edema | Mild nonproliferative diabetic retinopathy without macular edema |
| E10.331 | Type 1 DM with moderate NPDR with macular edema | Moderate NPDR with macular edema |
| E10.339 | Type 1 DM with moderate NPDR without macular edema | Moderate NPDR without macular edema |
| E10.341 | Type 1 DM with severe NPDR with macular edema | Severe NPDR with macular edema |
| E10.349 | Type 1 DM with severe NPDR without macular edema | Severe NPDR without macular edema |
| E10.351 | Type 1 DM with proliferative retinopathy with macular edema | PDR with macular edema, often needing laser treatment |
| E10.359 | Type 1 DM with proliferative retinopathy without macular edema | PDR without macular edema |
| E10.36 | Type 1 DM with diabetic cataract | Cataract due to type 1 diabetes |
| E10.40 | Type 1 DM with diabetic neuropathy, unspecified | Diabetic neuropathy NOS in type 1 |
| E10.41 | Type 1 DM with diabetic mononeuropathy | Single nerve involvement in type 1 |
| E10.42 | Type 1 DM with diabetic polyneuropathy | Distal symmetric polyneuropathy in type 1 |
| E10.43 | Type 1 DM with diabetic autonomic neuropathy | Autonomic neuropathy (gastroparesis, orthostatic hypotension) |
| E10.44 | Type 1 DM with diabetic amyotrophy | Proximal motor neuropathy with muscle wasting |
| E10.51 | Type 1 DM with diabetic peripheral angiopathy without gangrene | Peripheral vascular disease without gangrene |
| E10.52 | Type 1 DM with diabetic peripheral angiopathy with gangrene | PVD with gangrene in type 1 diabetes |
| E10.610 | Type 1 DM with diabetic neuropathic arthropathy | Charcot joint from type 1 diabetes |
| E10.621 | Type 1 DM with foot ulcer | Diabetic foot ulcer in type 1; also code site L97.x |
| E10.641 | Type 1 DM with hypoglycemia with coma | Severe hypoglycemia with loss of consciousness |
| E10.649 | Type 1 DM with hypoglycemia without coma | Hypoglycemic episode without coma |
| E10.69 | Type 1 DM with other specified complication | Other complications not elsewhere classified |
| E10.8 | Type 1 DM with unspecified complications | When complications are present but not specified |
Coding Tip: Type 1 vs Type 2 Insulin Use
Do not assign code Z79.4 (long term current use of insulin) for type 1 diabetes patients. Insulin use is inherent to the E10 category. Z79.4 is only assigned as an additional code for type 2 (E11), secondary (E08, E09), or other specified diabetes (E13) when the patient uses insulin to distinguish them from patients managed without insulin.
Gestational Diabetes Mellitus (O24.4) Codes
Gestational diabetes mellitus (GDM) is diabetes first diagnosed during pregnancy (typically between 24-28 weeks). These codes are only used during pregnancy. Pre-existing diabetes in pregnancy uses O24.0 (type 1) or O24.1 (type 2). Always assign a code from Z3A to indicate weeks of gestation with any O24.4 code.
| Code | Description | Clinical Scenario |
|---|---|---|
| O24.410 | GDM in pregnancy, diet controlled | GDM managed with medical nutrition therapy alone |
| O24.414 | GDM in pregnancy, insulin controlled | GDM requiring insulin therapy for glucose control |
| O24.415 | GDM in pregnancy, controlled by oral hypoglycemic drugs | GDM managed with metformin or glyburide |
| O24.419 | GDM in pregnancy, unspecified control | GDM when control method is not documented |
| O24.420 | GDM in childbirth, diet controlled | GDM during labor/delivery, diet controlled |
| O24.424 | GDM in childbirth, insulin controlled | GDM during labor/delivery, on insulin |
| O24.425 | GDM in childbirth, controlled by oral hypoglycemic drugs | GDM during delivery, managed with oral meds |
| O24.429 | GDM in childbirth, unspecified control | GDM during delivery, control method not specified |
| O24.430 | GDM in the puerperium, diet controlled | Postpartum GDM managed with diet only |
| O24.434 | GDM in the puerperium, insulin controlled | Postpartum GDM on insulin |
| O24.435 | GDM in the puerperium, controlled by oral hypoglycemic drugs | Postpartum GDM on oral agents |
| O24.439 | GDM in the puerperium, unspecified control | Postpartum GDM, control not specified |
Gestational vs Pre-existing Diabetes
If a patient has pre-existing type 1 or type 2 diabetes and becomes pregnant, do not use O24.4. Instead, use O24.011-O24.013 (pre-existing type 1 DM in pregnancy) or O24.111-O24.113 (pre-existing type 2 DM in pregnancy). Code the pre-existing E10 or E11 code with any complications as additional codes.
Diabetes Complications Coding Guide
ICD-10-CM uses combination codes for diabetes with complications. A single code captures both the diabetes type and the specific complication. Understanding these coding principles is essential for accurate claims submission and avoiding denials.
Combination Codes
Diabetes complication codes are combination codes that include both the type of diabetes and the body system complication. You do not need a separate code for the diabetes itself.
E11.42 = Type 2 DM + Polyneuropathy
(One code captures both conditions)
The Word "With"
Per ICD-10-CM guidelines, the word "with" in the Alphabetic Index is interpreted to mean "associated with" or "due to." For diabetes, a causal relationship between diabetes and the complication is assumed unless documented otherwise.
If a patient has type 2 DM and CKD, code E11.22 unless the provider documents the CKD is unrelated to diabetes.
Multiple Complications
Assign as many combination codes as needed from the same diabetes category to fully describe all complications. Each complication gets its own combination code.
Patient with type 2 DM + neuropathy + CKD:
E11.42 + E11.22 + N18.x
Uncontrolled Diabetes Coding
"Uncontrolled," "inadequately controlled," or "out of control" diabetes is coded based on whether the patient has hyperglycemia or hypoglycemia. Documentation must specify the direction.
High blood sugar: E11.65 (hyperglycemia)
Low blood sugar: E11.649 (hypoglycemia w/o coma)
Sequencing Rules for Diabetes Codes
- 1.For E08 (diabetes due to underlying condition), sequence the underlying condition first, then the E08 code.
- 2.For E09 (drug-induced diabetes), sequence the E09 code first, then an additional code for the adverse effect (T36-T50 with 5th or 6th character 5) to identify the drug.
- 3.When diabetes is the reason for the encounter, sequence the diabetes combination code as the principal/first-listed diagnosis.
- 4.Use additional codes for CKD stage (N18.x), foot/skin ulcer site (L97.x), or insulin pump status (Z96.41) as applicable.
HbA1c and Related Status Codes
In addition to the primary diabetes diagnosis codes, several status and screening codes are frequently used alongside diabetes codes to provide a complete clinical picture. These codes support medical necessity for lab testing and monitor treatment adherence.
| Code | Description | When to Use |
|---|---|---|
| Z13.1 | Encounter for screening for diabetes mellitus | Screening encounter for patients without symptoms or diagnosis |
| R73.01 | Impaired fasting glucose | Fasting glucose 100-125 mg/dL, prediabetes state |
| R73.02 | Impaired glucose tolerance (oral) | OGTT 2-hour glucose 140-199 mg/dL |
| R73.03 | Prediabetes | HbA1c 5.7-6.4% or documented prediabetes |
| R73.09 | Other abnormal glucose | Abnormal glucose findings not elsewhere classified |
| Z79.4 | Long term (current) use of insulin | Type 2, E08, E09, or E13 diabetes patients on insulin |
| Z79.84 | Long term (current) use of oral hypoglycemic drugs | Patients on oral diabetes medications (metformin, sulfonylureas, etc.) |
| Z79.899 | Other long term (current) drug therapy | Non-insulin injectable diabetes medications (GLP-1 agonists) |
| Z96.41 | Presence of insulin pump | Patient with implanted or external insulin pump |
| Z86.32 | Personal history of gestational diabetes | History of GDM in previous pregnancy, not currently pregnant |
HbA1c Monitoring
While there is no specific ICD-10 code for a specific HbA1c level, the diabetes code itself (E10/E11) supports medical necessity for HbA1c testing. Use E11.65 (with hyperglycemia) when the HbA1c is above the target range, typically above 7.0% per ADA guidelines.
GLP-1 Agonist Coding
For patients on GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide), use Z79.899 (other long term drug therapy) as an additional code. These are neither insulin (Z79.4) nor oral hypoglycemics (Z79.84) as they are injectable non-insulin medications.
Documentation Requirements for Accurate Diabetes Coding
Accurate diabetes coding depends entirely on thorough clinical documentation. The following elements must be clearly documented in the medical record to support proper code selection and avoid audit vulnerabilities. Refer to the CMS ICD-10-CM Official Guidelines for complete documentation standards.
Type of Diabetes
- Specify type 1, type 2, gestational, or secondary
- For secondary diabetes, document the underlying cause
- Avoid ambiguous terms like "borderline" or "sugar diabetes"
Complications and Relationships
- Document each complication explicitly
- State relationship: "diabetic nephropathy" vs "CKD, unrelated to diabetes"
- Specify laterality for eye conditions (right, left, bilateral)
Level of Control
- Document "controlled," "uncontrolled," "poorly controlled"
- Specify hyperglycemia vs hypoglycemia for uncontrolled
- Include most recent HbA1c value and date
Current Medications
- List all diabetes medications (insulin, oral agents, injectables)
- Note insulin pump use if applicable
- Document dietary management if used as primary treatment
Monitoring Parameters to Document
Lab Values
- - HbA1c (most recent with date)
- - Fasting glucose / random glucose
- - eGFR and serum creatinine
- - Urine albumin-to-creatinine ratio
- - Lipid panel results
Physical Exam
- - Foot examination findings
- - Monofilament / vibration testing
- - Blood pressure
- - BMI
- - Skin integrity assessment
Referral Status
- - Last dilated eye exam date
- - Nephrology referral if applicable
- - Podiatry referral if applicable
- - Diabetes education referral
- - Nutritionist referral
For more on clinical documentation best practices, see our Clinical Documentation Integrity Guide and Common Medical Coding Errors.
Medicare Considerations for Diabetes Coding
Diabetes is a significant focus for Medicare quality measurement and risk adjustment. Accurate coding directly impacts reimbursement, quality scores, and risk adjustment factor (RAF) calculations for Medicare Advantage plans.
HCC Risk Adjustment
Diabetes codes carry significant Hierarchical Condition Category (HCC) weight in Medicare Advantage risk adjustment:
- - HCC 17: Diabetes with acute complications (DKA, hyperosmolarity)
- - HCC 18: Diabetes with chronic complications (nephropathy, retinopathy, neuropathy)
- - HCC 19: Diabetes without complication
- - Specificity of complication coding directly impacts RAF scores
HEDIS Quality Measures
Key HEDIS diabetes measures affecting quality ratings:
- - CDC: Comprehensive Diabetes Care (HbA1c testing, eye exam, nephropathy screening)
- - HbA1c Control: Percentage of patients with HbA1c <8% or >9% (poor control)
- - Blood Pressure: BP control <140/90 in diabetic patients
- - Statin Therapy: Statin use in diabetes patients aged 40-75
Annual Recapture Requirement
Medicare Advantage requires that all HCC diagnoses be recaptured (re-documented and re-coded) annually. Diabetes and its complications must be documented at least once per calendar year to maintain accurate risk adjustment. Ensure each visit addresses and documents all active diabetes-related conditions for proper year-over-year coding continuity.
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Frequently Asked Questions
What is the ICD-10 code for type 2 diabetes?
The ICD-10 code for type 2 diabetes mellitus without complications is E11.9. For type 2 diabetes with hyperglycemia (uncontrolled, high blood sugar), use E11.65. The E11 category covers all type 2 diabetes codes, with 4th, 5th, and 6th characters specifying the type and severity of any associated complications.
What is the ICD-10 code for uncontrolled diabetes?
Uncontrolled diabetes is coded based on the type of uncontrolled state. For type 2 diabetes with hyperglycemia (high blood sugar), use E11.65. For type 2 diabetes with hypoglycemia without coma, use E11.649. For type 1 diabetes with hyperglycemia, use E10.65, and with hypoglycemia without coma, use E10.649. There is no single "uncontrolled diabetes" code; the documentation must specify the type of poor control.
How do you code diabetes with complications in ICD-10?
Diabetes with complications uses combination codes from the E08-E13 categories. A single code captures both the diabetes type and the complication. For example, E11.21 captures type 2 diabetes with diabetic nephropathy, and E11.311 captures type 2 diabetes with unspecified diabetic retinopathy. If a patient has multiple complications, assign as many combination codes as needed to fully describe the conditions.
What is the difference between E11.9 and E11.65?
E11.9 is "Type 2 diabetes mellitus without complications" and is used when diabetes is documented without any associated complications and is adequately controlled. E11.65 is "Type 2 diabetes mellitus with hyperglycemia" and is used when documentation indicates the diabetes is poorly controlled, inadequately controlled, or out of control with elevated blood glucose. The key distinction is the level of glycemic control documented by the provider.
What is the ICD-10 code for diabetic neuropathy?
Diabetic neuropathy codes depend on the type of diabetes and specific neuropathy. For type 2 diabetes with diabetic neuropathy, unspecified, use E11.40. For type 2 diabetes with diabetic mononeuropathy, use E11.41. For type 2 diabetes with diabetic polyneuropathy, use E11.42. For type 2 diabetes with diabetic autonomic neuropathy, use E11.43. For type 1 diabetes, use the corresponding E10.4x codes.
Do you code insulin use separately for type 2 diabetes?
Yes. When a patient with type 2 diabetes uses insulin, assign Z79.4 (Long term current use of insulin) as an additional code. This is important because type 2 diabetes does not inherently require insulin. For patients on oral hypoglycemic agents, add Z79.84 (Long term current use of oral hypoglycemic drugs). Do not assign Z79.4 for type 1 diabetes, as insulin use is inherent to the disease.
What is the ICD-10 code for gestational diabetes?
Gestational diabetes codes are under O24.4. Use O24.410 for gestational diabetes in pregnancy, diet controlled. Use O24.414 for gestational diabetes in pregnancy, insulin controlled. Use O24.415 for gestational diabetes controlled by oral hypoglycemic drugs. Use O24.419 for gestational diabetes in pregnancy, unspecified control. Always assign a code from category Z3A to indicate weeks of gestation.
How do you code type 1 diabetes vs type 2 in ICD-10?
Type 1 diabetes uses E10 category codes, while type 2 diabetes uses E11 category codes. The subcategory structure is parallel: both use .9 for without complications, .65 for hyperglycemia, .40-.44 for neurological complications, .21-.29 for kidney complications, and so on. If the type of diabetes is not documented, the default is type 2 (E11). Type 1 diabetes is always insulin-dependent, so Z79.4 is not additionally coded for E10.
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