The ICD10 code for type 1 diabetes is E10.x
The ICD10 code for type 2 diabetes is E11.x
There is no code for LADA. LADA is slang for type 1 that occurs in adulthood.
John
ICD-10 (like ICD-9) from a healthcare perspective is totally beyond useless. It is a coding system for insurance and public health reporting and it frankly does a lousy job. If you read the definitions they are confused and unclear. Of course LADA isn’t covered, neither is MODY or any of a wide range of diabetes types. And the coding cannot properly differentiate type 1 or type 2. The vast majority of people with diabetes can basically be coded properly as E10 or E11. Most patients with diabetes would do best in the healthcare system by advocating that they should properly be coded as E10 in order to get the best covered access to healthcare.
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Wouldn’t you say LADA is actually more of a descriptive term for type 1 that presents in adults in a specific manner – i.e., very slowly progressing and not necessarily requiring insulin at diagnosis?
EDIT to clarify that i wasn’t speaking in any manner toward the ICD10 code. Rather, I was responding to the original comment that LADA was simply slang. My point was that I think it’s more descriptive than slang.
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LADA is most typically adult-onset, thus it would probably fall into E11 Type 2 which specifically calls out adult-onset. There is actually no diagnostic criteria for type 1 or type 2. You would expect type 1 to say something like “includes autoimmune type 1 as indicated by positive antibodies and insulin deficiency.”
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It seems like there is no clinical benefit to either the provider or the patient, just the bean counters. I’ll have to carefully monitor the codes when I visit a lab next week and my endo the following week. I’ll be watching for the E10 code.
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Type 1 is an autoimmune disease whereby the immune system produces antibodies to destroy cells. There is little to no insulin produced by Type 1 because the insulin producing beta cells are absent.
Type 2 is insulin resistance whereby the cell receptors are resistant to insulin. Type 2 diabetics usually produce plenty of insulin.
Either one can occur at any age. The age factor makes no difference whatsoever in the disease itself.
John
True WITH the proviso that
- Type 1 and insulin resistance can occur together, and
- Type 2 can have the long term result of impairing the islets’ ability to produce insulin; consequently, after enough years have gone by, Type 2 can behave very much like Type 1.
The second scenario can result in a Type 2 with relatively little insulin resistance and very little endogenous insulin. Brian and I are good examples. My TDD is 20 or less and my c-pep is barely detectable. There’s not a lot of IR to overcome there.
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From a physician’s perspective, I agree with this 100%. No clinical benefit whatsoever, plus a major pain in my big, fat butt to boot!
But if I don’t use the correct ICD-10 code(s) AND the correct CPT code(s), I don’t get paid…
I’ve often said that I think the entire type 1 / type 2 model benefits nobody but the bean counters… Least of all the patients— I think we’ve effectively been duped—
As someone who is studying health information management, in my opinion the switch to ICD-10 was necessary. Other countries having been using ICD-10 for years and some are even making the switch to ICD-11 while we are just starting to use ICD-10 now. This made it hard for the United States to keep up with other countries when it came to healthcare. ICD-9 was very outdated. Also, there was a huge advantage to switching to ICD-10 when it comes to accurately recording medical data. ICD-9 only had 13,000 where as ICD-10 has 68,000 codes.
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More codes don’t mean greater accuracy. They just mean more codes. Accurate codes mean greater accuracy. If the rest of ICD-10 is as incomplete and imprecise as the diabetes section, that goal has not been achieved.
More codes means more granularity – in theory. In all likelihood, it will result in more errors, though, first reports of ICD-10 results have indicated neither better nor worse accuracy, at least when it comes to reimbursable claims (Medicare). One thing more code likely does mean: more Health IT and Health Informatics (me) jobs 
I couldn’t agree more with this! Quite a handful of the ICD-9 codes I used to use appear to be far more accurate than some of the ICD-10 codes.
Thanks for your post, Brian! It helps clarify what we code we should be looking for in our own records!
Best wishes,
marty1492
I’ve had that impression about LADA too, some people going years from initial “issues”, often leading to a T2 DX and then migrating to T1 over time. I haven’t seen that many kid histories of diabetes happening that way.
Re the codes, I agree that they have shortcomings but one that is really critical is that coverage follows codes in many cases. I don’t agree that T2 should be short supplied but they are.
My solution to that would be to make blood sugar testing a civil right. I don’t think anyone does it for fun and even an OCD can only test so much. Just let us test and see what happens. I don’t see it causing a public health crisis and I think that it would be a healthier way to approach testing and management of costs. The money insurers pay out could very well be saved to the system by relieving doctors from the hassle of writing stupid “letters of medical necessity” for their patients, insurers from having armies of nurses redlining test strips, etc. Put those resources into care, not the sort of “Crimson Mutual Assurance” scenarios this whole song-and-dance seems like to me.
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No surprises here. Insurers are historically and traditionally prone to “penny wise/pound foolish” decision making. Must be something inherent in the actuarial mind. The evidence is abundant that frequent testing would save them much more than it would cost. The evidence is overwhelming that providing pumps and CGMs to any diabetic requesting them would result in a net saving of $ billions a year. But they don’t do any of those things.
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FYI…The ICD is not designed to manage conditions, or offer insurance advantages, or anything like that. It’s purpose is to Track, Classify, Process, and Present mortality data. Changes are ever necessary as there are new conditions, advances in care, and so on.
The coding system is the INTERNATIONAL CLASSIFICATION OF DISEASES and it is used every dang where. The coding is of course needed to make sure your provider gets paid (and it for sure is necessary and best to have the right code assigned!!), but it is more important so the WHO has true mortality data.
Do check your codes on all of your charts, and EOBs, and don’t stop at the ICD…take a look at the CPT codes as well, those mistakes are costly as well.
Regardless of whether it was designed to “offer insurance advantages”, I can most definitely vouch for the fact that insurance providers use ICD codes to their advantage in their never-ending quest to deny providers like myself fair reimbursement for our hard work!
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Bull’s eye. What it was “intended” for is beside the immediate point. How it’s actually USED is what gives rise to this concern.
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