Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults

Last updated July 7, 2022

Key Points

Key Points

Advances in the pharmacokinetics and pharmacodynamics of insulin products and in the methods of insulin delivery and glucose monitoring are geared toward improving glucose control, minimizing hypoglycemia, and improving quality of life. Two such advances are continuous subcutaneous insulin infusion (CSII) and real-time continuous glucose monitoring (RT-CGM).

Success of these devices and technologies is directly linked to the level to which people are educated, capable, and willing to use them.

This guideline attempts to assess all available data on existing and emerging technologies and procedures for improving glucose control for patients with diabetes.

Treatment

Treatment

Insulin Pump Therapy Without Sensor Augmentation

Endocrine Society (ES) recommends CSII over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1-M)
699
ES recommends CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. ( 1-L )
699
ES suggests CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2-L)
699

Insulin Pump Therapy in Type 2 Diabetes Mellitus

ES suggests CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2-L)
699

Insulin Pump Use in the Hospital

ES suggests that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures. (2-L)
699

Selection of Candidates for Insulin Pump Therapy

ES recommends that before prescribing CSII, clinicians perform a structured assessment of a patient’s mental and psychological status, prior adherence to diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits. ( 1-L )
699

Use of Bolus Calculators in Insulin Pump Therapy

ES suggests encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations. (2-L)
699

Real-Time Continuous Glucose Monitors in Adult Outpatients

ES recommends RT-CGM devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis. ( 1-H )
699
ES recommends RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis. ( 1-H )
699

Use of Continuous Glucose Monitoring in Adults With Type 2 Diabetes Mellitus

ES suggests short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels ≥7% and are willing and able to use the device. ( 2-L )
699

Education and Training on the Use of Continuous Subcutaneous Insulin Infusion and Continuous Glucose Monitoring

ES suggests that adults with T1DM and T2DM who use CSII and continuous glucose monitoring (CGM) receive education, training, and ongoing support to help achieve and maintain individualized glycemic goals. (UGPS)
699

Table 1. CSII—Considerations for Education and Training

Patient
Collaborate with health care professional (HCP) overseeing CSII use and/or the multidisciplinary diabetes team by returning for follow-up. Participate in using data management resources to make adjustments to therapy and evaluate self-care behaviors.
Provider
Provide education as indicated to address deficiencies or when upgrading to new technology.
Assess CSII use and evaluate for the loss of ability to operate insulin pump due to cognitive, physical, or age-related changes; changes in insurance coverage; or changes in the healthcare provider managing CSII use.
Time periods to assess patient self-care behaviors and knowledge before initiating CSII, assess:
Glucose monitoring via self-monitoring blood glucose (SMBG) frequency, and/or CGM use defined by HCP to meet individualized glycemic goals.
Carbohydrate counting or another method of mealtime bolus determination.
Ability to operate CSII and make setting changes due to factors such as dexterity, vision impairment, mental health, or cognition—independently or with assistance from a designated care provider.
Infusion site health and selection.
DKA prevention and treatment.
Hypoglycemia—prevention, detection, and treatment.
Emergency supplies.
If using bolus calculator, assess these settings: insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets, and active insulin time.
Annually and/or when upgrading to a new CSII device, re-assess:
Glucose monitoring via SMBG frequency and/or CGM use defined by HCP to meet individualized glycemic goals.
Basal settings via basal rate testing across different time periods, adjust as indicated.
Bolus calculator settings, if using feature, adjust as indicated.
Infusion sites and type of infusion set, adjust as indicated.
Ability to troubleshoot insulin pump malfunction.
DKA prevention and treatment.
Hypoglycemia prevention, detection, and treatment.
Emergency supplies.
Back-up plan for use of injected insulin should pump fail.
When discontinuing CSII or transitioning to MDI, re-assess:
Glucose monitoring via SMBG frequency and/or CGM use defined by HCP to meet individualized glycemic goals. New insulin plan for MDI.

Table 2. RT-CGM Technology—Considerations for Education and Training for Personal Use 

Patient

Collaborate with HCP overseeing RT-CGM use and/or the multidisciplinary diabetes team by returning for follow-up.

Participate in use of data management resources to make adjustments to therapy and evaluate self-care behaviors.

Provider

Provide education as indicated to address deficiencies or when upgrading to new CGM technology.

On an ongoing basis, assess CGM use and evaluate for the loss of ability to operate CGM system due to: cognitive, physical, or age-related changes; changes in insurance coverage; or changes in the healthcare provider managing CGM use.

Time periods to assess patient self-care behaviors and knowledge

Before initiating RT-CGM, assess:

Patient understanding that CGM does not replace SMBG.

Factors and self-care behaviors that may influence success with CGM.

When initiating RT-CGM, assess:

Knowledge of CGM system components—receiver, sensor, and transmitter.

Understanding of how CGM data differ from SMBG data.

Use of trend information based on changing glucose levels to adjust insulin doses.

Use of SMBG to calibrate CGM system.

Site selection and care.

Alarms (Check that alarms are set in a fashion to optimize patient benefit and minimize alarm fatigue. The initial focus is often on low alerts and falling blood glucose alarms. High alerts can be turned off or set well above target at first if patient is consistently high and doesn’t benefit from high alerts.)

Annually and/or when upgrading technology (for ongoing RT-CGM use), re-assess:

Ability to make insulin adjustment based on trend information.

Use of SMBG to calibrate.

Sensor site health and care.


Table 3. Suggested Health Care Provider Resources to Support the Safe and Effective Use of CSII and RT-CGM

Clinicians should implement a formalized educational plan for the initiation and long-term support of CSII and RT-CGM that is established by the practice setting. Clinicians should communicate education plans to potential candidates and individuals new to the practice setting.
Clinics should have a designated multidisciplinary diabetes team to evaluate potential candidates, initiate therapy and education, and to support long-term CSII and RT-CGM use that is part of the practice setting. Alternatively, a sole practitioner may also provide medical care and CSII education supported by other healthcare professionals or industry consultants as indicated. CSII and RT-CGM diabetes care team members could include the following health care providers: endocrinologist, advanced practice registered nurse, physician’s assistant, primary care provider, certified diabetes educator, registered dietitian with expertise in diabetes medical nutrition therapy, and mental health/behavioral therapists.
The clinical support staff or patient should know how to download data from glucose meters, insulin pumps, and RT-CGMs, and they should download data before an appointment in order to review data via print format, online secure patient pump portal, or the patient’s electronic health record.
Designated staff members (diabetes educators, medical assistants, or patient service representatives) should be available to help clinics obtain prior authorizations, schedule peer-to-peer reviews, submit supporting documents for determining coverage, answer insurance and distributor/third party vendor queries for additional documentation, and issue letters of support and/or appeal if therapy is declined.

Recommendation Grading

Abbreviations

  • CGM: Continuous Glucose Monitoring
  • CSII: Continuous Subcutaneous Insulin Infusion
  • DKA: Diabetes Ketoacidosis
  • HCP: Health Care Professional
  • MDI: Multiple Daily Injections
  • RT-CGM: Real-time CGM
  • SMBG: Self-monitoring Blood Glucose
  • T1DM: Type 1 Diabetes Mellitus
  • T2DM: Type 2 Diabetes Mellitus

Source Citation

Anne L. Peters, Andrew J. Ahmann, Tadej Battelino, Alison Evert, Irl B. Hirsch, M. Hassan Murad, William E. Winter, Howard Wolpert, Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 11, 1 November 2016, Pages 3922–3937, https://doi.org/10.1210/jc.2016-2534

Disclaimer

This pocket guide attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. This pocket guide should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician after consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.

Codes

CPT Codes

Code Descriptor
96170 Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
96156 Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
98962 Education and training for patient self-management by a qualified
98961 Education and training for patient self-management by a qualified
96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
99078 Physician or other qualified health care professional qualified by education
96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
98960 Education and training for patient self-management by a qualified
0592T Health and well-being coaching face-to-face; individual
96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
96168 Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
0593T Health and well-being coaching face-to-face; group (2 or more individuals)
96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
0591T Health and well-being coaching face-to-face; individual

ICD-10 Codes

Code Descriptor Documentation Concepts Quality/Performance
E10.9 Type 1 diabetes mellitus without complications Type, caused by due to, complications or manifestations, laterality
E09.3522 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E10.3492 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E11.59 Type 2 diabetes mellitus with other circulatory complications Type, caused by due to, complications or manifestations, laterality
E09.39 Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication Type, caused by due to, complications or manifestations, laterality
E13.621 Other specified diabetes mellitus with foot ulcer Type, caused by due to, complications or manifestations, laterality
E10.3312 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.628 Type 1 diabetes mellitus with other skin complications Type, caused by due to, complications or manifestations, laterality
E11.628 Type 2 diabetes mellitus with other skin complications Type, caused by due to, complications or manifestations, laterality
E11.3532 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E08.43 Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy Type, caused by due to, complications or manifestations, laterality
E11.3549 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema Type, caused by due to, complications or manifestations, laterality
E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema Type, caused by due to, complications or manifestations, laterality
E13.3412 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E08.3553 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3292 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease Type, caused by due to, complications or manifestations, laterality
E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy Type, caused by due to, complications or manifestations, laterality
E13.37X2 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye Type, caused by due to, complications or manifestations, laterality
E09.3559 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3512 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.3543 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type, caused by due to, complications or manifestations, laterality
E13.3392 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E13.3541 Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye Type, caused by due to, complications or manifestations, laterality
E08.59 Diabetes mellitus due to underlying condition with other circulatory complications Type, caused by due to, complications or manifestations, laterality
E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication Type, caused by due to, complications or manifestations, laterality
E08.3532 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E13.29 Other specified diabetes mellitus with other diabetic kidney complication Type, caused by due to, complications or manifestations, laterality
E09.3312 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy Type, caused by due to, complications or manifestations, laterality
E10.3522 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E09.3492 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E13.44 Other specified diabetes mellitus with diabetic amyotrophy Type, caused by due to, complications or manifestations, laterality
E10.3559 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.3512 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E09.3543 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type, caused by due to, complications or manifestations, laterality
E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E13.0 Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) Type, complications/manifestations, due to/caused by, temporal factors RXHCC30, HCC17
E10.649 Type 1 diabetes mellitus with hypoglycemia without coma Type, caused by due to, complications or manifestations, laterality
E11.649 Type 2 diabetes mellitus with hypoglycemia without coma Type, caused by due to, complications or manifestations, laterality
E08.3549 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease Type, caused by due to, complications or manifestations, laterality
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy Type, caused by due to, complications or manifestations, laterality
E11.3553 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral Type, caused by due to, complications or manifestations, laterality
E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene Type, caused by due to, complications or manifestations, laterality
E11.3552 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye Type, caused by due to, complications or manifestations, laterality
E09.37X1 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Type, caused by due to, complications or manifestations, laterality
E10.3519 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy Type, caused by due to, complications or manifestations, laterality
E09.3411 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication Type, caused by due to, complications or manifestations, laterality
E09.59 Drug or chemical induced diabetes mellitus with other circulatory complications Type, caused by due to, complications or manifestations, laterality
E13.641 Other specified diabetes mellitus with hypoglycemia with coma Type, caused by due to, complications or manifestations, laterality
E08.610 Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy Type, caused by due to, complications or manifestations, laterality
E09.610 Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy Type, caused by due to, complications or manifestations, laterality
E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E13.1 Other specified diabetes mellitus with hyperosmolarity with coma Type, complications/manifestations, due to/caused by, temporal factors RXHCC30, HCC17
E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E09.3542 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type, caused by due to, complications or manifestations, laterality
E09.3391 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E10.3299 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3319 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye Type, caused by due to, complications or manifestations, laterality
E13.69 Other specified diabetes mellitus with other specified complication Type, caused by due to, complications or manifestations, laterality
E09.3539 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E09.3493 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E10.3523 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E11.3211 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.3599 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy Type, caused by due to, complications or manifestations, laterality
E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease Type, caused by due to, complications or manifestations, laterality
E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.3219 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E09.3313 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E11.3529 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3499 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3533 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E09.3299 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3393 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3513 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E10.3542 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type, caused by due to, complications or manifestations, laterality
E10.3391 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E10.3411 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.37X3 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3293 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E09.43 Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy Type, caused by due to, complications or manifestations, laterality
E13.3413 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3552 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye Type, caused by due to, complications or manifestations, laterality
E08.39 Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication Type, caused by due to, complications or manifestations, laterality
E10.59 Type 1 diabetes mellitus with other circulatory complications Type, caused by due to, complications or manifestations, laterality
E10.37X1 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Type, caused by due to, complications or manifestations, laterality
E13.319 Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema Type, caused by due to, complications or manifestations, laterality
E13.49 Other specified diabetes mellitus with other diabetic neurological complication Type, caused by due to, complications or manifestations, laterality
E09.3519 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy Type, caused by due to, complications or manifestations, laterality
E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease Type, caused by due to, complications or manifestations, laterality
E08.3529 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3311 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E11.3499 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.3533 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3591 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.65 Other specified diabetes mellitus with hyperglycemia Type, caused by due to, complications or manifestations, laterality
E10.3313 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E13.620 Other specified diabetes mellitus with diabetic dermatitis Type, caused by due to, complications or manifestations, laterality
E10.3539 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.3493 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E09.3523 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3211 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.3491 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E08.630 Diabetes mellitus due to underlying condition with periodontal disease Type, caused by due to, complications or manifestations, laterality
E11.3319 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E09.630 Drug or chemical induced diabetes mellitus with periodontal disease Type, caused by due to, complications or manifestations, laterality
E10.8 Type 1 diabetes mellitus with unspecified complications Type, caused by due to, complications or manifestations, laterality
E11.3312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.3532 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E10.622 Type 1 diabetes mellitus with other skin ulcer Type, caused by due to, complications or manifestations, laterality
E11.622 Type 2 diabetes mellitus with other skin ulcer Type, caused by due to, complications or manifestations, laterality
E08.49 Diabetes mellitus due to underlying condition with other diabetic neurological complication Type, caused by due to, complications or manifestations, laterality
E10.29 Type 1 diabetes mellitus with other diabetic kidney complication Type, caused by due to, complications or manifestations, laterality
E08.3522 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication Type, caused by due to, complications or manifestations, laterality
E11.3492 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E08.3559 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene Type, caused by due to, complications or manifestations, laterality
E11.3543 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type, caused by due to, complications or manifestations, laterality
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy Type, caused by due to, complications or manifestations, laterality
E09.3512 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.3549 Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Type, caused by due to, complications or manifestations, laterality
E09.3553 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral Type, caused by due to, complications or manifestations, laterality
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy Type, caused by due to, complications or manifestations, laterality
E09.3292 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.618 Type 1 diabetes mellitus with other diabetic arthropathy Type, caused by due to, complications or manifestations, laterality
E11.618 Type 2 diabetes mellitus with other diabetic arthropathy Type, caused by due to, complications or manifestations, laterality
E11.69 Type 2 diabetes mellitus with other specified complication Type, caused by due to, complications or manifestations, laterality
E11.3522 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E08.3492 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E11.49 Type 2 diabetes mellitus with other diabetic neurological complication Type, caused by due to, complications or manifestations, laterality
E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication Type, caused by due to, complications or manifestations, laterality
E13.3212 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E10.638 Type 1 diabetes mellitus with other oral complications Type, caused by due to, complications or manifestations, laterality
E11.638 Type 2 diabetes mellitus with other oral complications Type, caused by due to, complications or manifestations, laterality
E09.3532 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type, caused by due to, complications or manifestations, laterality
E13.3592 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E08.3312 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E08.621 Diabetes mellitus due to underlying condition with foot ulcer Type, caused by due to, complications or manifestations, laterality
E09.621 Drug or chemical induced diabetes mellitus with foot ulcer Type, caused by due to, complications or manifestations, laterality
E10.3292 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E13.3551 Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye Type, caused by due to, complications or manifestations, laterality
E08.9 Diabetes mellitus due to underlying condition without complications Type, caused by due to, complications or manifestations, laterality
E09.44 Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy Type, caused by due to, complications or manifestations, laterality
E09.3549 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.69 Diabetes mellitus due to underlying condition with other specified complication Type, caused by due to, complications or manifestations, laterality
E10.3553 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral Type, caused by due to, complications or manifestations, laterality
E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene Type, caused by due to, complications or manifestations, laterality
E11.3559 Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.65 Type 2 diabetes mellitus with hyperglycemia Type, caused by due to, complications or manifestations, laterality
E08.3543 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type, caused by due to, complications or manifestations, laterality
E10.3512 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Type, caused by due to, complications or manifestations, laterality
E08.3542 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type, caused by due to, complications or manifestations, laterality
E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication Type, caused by due to, complications or manifestations, laterality
E10.49 Type 1 diabetes mellitus with other diabetic neurological complication Type, caused by due to, complications or manifestations, laterality
E10.3513 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E13.59 Other specified diabetes mellitus with other circulatory complications Type, caused by due to, complications or manifestations, laterality
E08.3391 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E11.3299 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3511 Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E08.37X1 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye Type, caused by due to, complications or manifestations, laterality
E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema Type, caused by due to, complications or manifestations, laterality
E09.319 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema Type, caused by due to, complications or manifestations, laterality
E10.3552 Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye Type, caused by due to, complications or manifestations, laterality
E11.3519 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3291 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E08.3411 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E08.8 Diabetes mellitus due to underlying condition with unspecified complications Type, caused by due to, complications or manifestations, laterality
E10.3293 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E11.101 Type 2 diabetes mellitus with hyperosmolarity with coma Type, complications/manifestations, due to/caused by, temporal factors RXHCC30, HCC17
E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy Type, caused by due to, complications or manifestations, laterality
E08.620 Diabetes mellitus due to underlying condition with diabetic dermatitis Type, caused by due to, complications or manifestations, laterality
E10.3591 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E09.620 Drug or chemical induced diabetes mellitus with diabetic dermatitis Type, caused by due to, complications or manifestations, laterality
E09.69 Drug or chemical induced diabetes mellitus with other specified complication Type, caused by due to, complications or manifestations, laterality
E08.3313 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E10.3529 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.3593 Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E09.3499 Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E09.3533 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E10.65 Type 1 diabetes mellitus with hyperglycemia Type, caused by due to, complications or manifestations, laterality
E09.3319 Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.630 Other specified diabetes mellitus with periodontal disease Type, caused by due to, complications or manifestations, laterality
E13.3213 Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E08.52 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene Type, caused by due to, complications or manifestations, laterality
E08.3539 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3493 Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease Type, caused by due to, complications or manifestations, laterality
E11.3523 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E10.3211 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E13.3399 Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy Type, caused by due to, complications or manifestations, laterality
E11.3411 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E08.641 Diabetes mellitus due to underlying condition with hypoglycemia with coma Type, caused by due to, complications or manifestations, laterality
E09.641 Drug or chemical induced diabetes mellitus with hypoglycemia with coma Type, caused by due to, complications or manifestations, laterality
E09.3293 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Type, caused by due to, complications or manifestations, laterality
E09.3552 Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye Type, caused by due to, complications or manifestations, laterality
E08.3519 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E08.3299 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.29 Type 2 diabetes mellitus with other diabetic kidney complication Type, caused by due to, complications or manifestations, laterality
E09.49 Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication Type, caused by due to, complications or manifestations, laterality
E13.37X9 Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.3542 Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type, caused by due to, complications or manifestations, laterality
E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy Type, caused by due to, complications or manifestations, laterality
E09.3513 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E13.3419 Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.3391 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E09.65 Drug or chemical induced diabetes mellitus with hyperglycemia Type, caused by due to, complications or manifestations, laterality
E11.3539 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.3493 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type, caused by due to, complications or manifestations, laterality
E08.3523 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality
E09.3211 Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Type, caused by due to, complications or manifestations, laterality
E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene Type, caused by due to, complications or manifestations, laterality
E10.3319 Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy Type, caused by due to, complications or manifestations, laterality
E09.3529 Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.3499 Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type, caused by due to, complications or manifestations, laterality
E10.69 Type 1 diabetes mellitus with other specified complication Type, caused by due to, complications or manifestations, laterality
E10.3533 Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Type, caused by due to, complications or manifestations, laterality