About 1 in 3 American adults has prediabetes, so the condition is almost certain to affect you, sooner or later, and directly or indirectly. Like any medical condition, prediabetes brings up the likelihood of healthcare, with communication and payment being critical elements of a smooth system.
The prediabetes ICD-10 code can clarify medical care for patients, providers, and insurers, and probably for you. Following are some questions you might have about it, and their simple answers.
Other ICD-10 codes are used to describe abnormal blood glucose levels that are from conditions besides prediabetes. For example, R73.9 designates “hyperglycemia, unspecified?”
The R73.03 ICD-10 code for prediabetes specifically excludes:
These each have different ICD-10 codes assigned to them.
Proclaiming that you or your patient has prediabetes can be an important step in managing it to delay or prevent the onset of type 2 diabetes. With the official classification of prediabetes on the record, patients could have more opportunities open to them.
One particularly important program is the Diabetes Prevention Program (DPP). This program is Fully CDC-Recognized as an effective way to lower your risk for type 2 diabetes. It has a year-long curriculum that focuses on weight loss, healthy eating, and physical activity.
Referring patients to DPP is an Improvement Activity within Medicare’s Merit-Based Incentive System (MIPS) program. Many patients in Medicare and with other coverage plan are eligible to enroll in a DPP without out-of-pocket cost.
You may even be able to join a digital Diabetes Prevention Program such as Lark, which enables you to experience the curriculum without going to in-person meetings. Lark DPP is a health coach with 24/7 availability on your smartphone.
The ICD-10 prediabetes classification is a good way to standardize patient care and billing. In a healthcare system that often seems scattered and overwhelming, that can only be a good thing for patients, providers, and insurers!
Lark Health is the leading chronic disease prevention and management platform using proven, A.I. health coaching to deliver better health outcomes at scale. Lark uses cutting edge A.I. and connected health monitors, which can be combined with clinical resources, to provide real-time, personalized, 24/7 support and counseling to help users make healthier choices and manage their conditions. Lark’s Diabetes Prevention Program (DPP), Wellness Program, Diabetes Care Program, and Hypertension Program serve over 1.9 million users, and have demonstrated clinically validated outcomes published in 11 peer-reviewed journals and analyst reports. Lark’s DPP, which is the fastest growing and lowest cost DPP, has received CDC Full Recognition. Lark works with some of the largest payers and self-insured employers to help their members live healthier lives. Founded by CEO Julia Hu in 2011, the company was named “Top 10 Most Innovative Companies in the World” alongside Uber and Airbnb, and Apple’s “Top 10 Apps of the Year”. To learn more, visit www.lark.com.
The ICD-10-CM classifications help patients, providers, and insurers to get on the same page regarding patient status. The standardized system, including a prediabetes ICD-10 code with specific criteria, reduce communication problems and potential conflict over the diagnosis, course of treatment, and payment requirements. For each group:
Another use of ICD-10-CM is for keeping statistics. The National Center for Health Statistics (NCHS) within the National Institutes of Health (NIH) uses ICD-10 data to monitor population health. Having a standard prediabetes ICD-10 code allows the NCHS to know how many people are diagnosed with prediabetes in a given year, and whether that number is increasing. These data are valuable when making decisions about funding, such as the decision to reimburse Diabetes Prevention Programs upon seeing the explosion in prediabetes in the population.
The International Code of Diagnostics (ICD) is the international system for streamlining medical care. The World Health Organization (WHO) has been publishing versions of the ICD since 1948. It is now on the tenth version, ICD-10, which has been adopted for use by over 100 countries, including the U.S.
Compared to ICD-9, ICD-10 has more codes and specificity. The former has 14,000 codes, while ICD-10 has over 70,000. In ICD-9, prediabetes falls under 790.29: “Other abnormal blood glucose.” Sharing this diagnosis include hypoglycemia, hyperglycemia due to steroids, prediabetes, and over 20 other symptoms.
While ICD-10-M is used for mortality statistics, ICD-10-CM [clinical modification] is used for morbidities, such as prediabetes and prediabetes symptoms. It has been used in the U.S. since 2015, and was published by the Centers for Medicare and Medicaid (CMS).