Check Out the AACE/ACE 2016 Update on

Standards of Medical Care in Diabetes

By Susan Dooley

Public health experts classify diabetes mellitus types 1 and 2 as major public health risks. In fact,
according to the Centers for Disease Control (CDC), one out of every three Americans, or 86 million
people, have prediabetes! With risks ranging from heart disease to limb loss and more, diabetes mellitus
is a frightening disease that is preventable, but first at-risk patients must be found so they can be taught
ways to avoid developing this disease.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
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AACE/ACE 2016 Update on Standards of Medical Care in Diabetes

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology
(ACE) recently released new clinical practice guidelines for diagnosis and treatment of prediabetes and
diabetes. These guidelines give clinicians clear cues that set into motion the tests that lead to diagnosis
of prediabetes and diabetes, which means education and treatment can start sooner.

Screening Prediabetes and Type 2 Diabetes Mellitus

The AACE/ACE Comprehensive Type 2 diabetes guidelines for screening for prediabetes and type 2
diabetes mellitus in asymptomatic adults now include the following criteria that would trigger the
provider to perform screening fasting glucose, hemoglobin A1c, and/or glucose tolerance tests.

Age 45 or older without other risk factors

Family history of type 2 diabetes
Personal history of cardiovascular disease
Overweight (specifically a BMI of greater than 30, or in the face of other risk factors, a BMI of 25
to 29.9)
Sedentary lifestyle
Member of an at-risk racial or ethnic group, including Asian, African American, Hispanic, Native
American, and Pacific Islander
High cholesterol (dyslipidemia) with an HDL of less than 35 mg/dL and triglycerides of greater
than 250 mg/dL
Impaired glucose tolerance, impaired fasting glucose, and/or metabolic syndrome
Diagnosis of polycystic ovary disease, acanthosis nigricans, or nonalcoholic fatty liver disease
Hypertension, defined as a blood pressure of 140/90 or greater, or requiring therapy for
hypertension
History of gestational diabetes or delivery of a baby weighing more than 9 lb
Under antipsychotic therapy for schizophrenia and/or severe bipolar disease
Chronic glucocorticoid (steroid) exposure
Sleep disorders such as obstructive sleep apnea, sleep deprivation, and night shift occupations
in the presence of glucose intolerance.

Getting the Diagnosis

Clinicians diagnose prediabetes, or being at high risk for diabetes, when patients fasting glucose is
between 100 and 125 mg/dL, glucose tolerance test is 140 to 199 mg/dL, and hemoglobin A1c is 5.5 to
6.4%. The A1c test is usually done first and is mainly used for screening prediabetes. The diagnosis of
prediabetes should be confirmed with glucose testing.
Clinicians look to confirm a diabetes mellitus diagnosis when patients hemoglobin A1c is greater than
6.5%. Values of glucose tolerance test of greater than 200 mg/dL and fasting blood glucose of 126 mg/dL
confirm the diagnosis of mellitus diagnosis.
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Coding for Prediabetes and Diabetes Prevention Education

You report the diagnosis for screening for diabetes mellitus with Z13.1 (Encounter for screening for
diabetes mellitus). If the results come back elevated, youd code the result. For example, if the A1c is
less than 6.5% and the fasting glucose is between 96 and 126, youd report R73.09 (Other abnormal
glucose). Note that the alternative terminology for this code includes abnormal glucose NOS, abnormal
non-fasting glucose tolerance, latent diabetes, and prediabetes. By the way, the preliminary list of ICD10-CM 2017 codes indicates well have a new code for prediabetes for DOS Oct. 1, 2016, and later. The
new code will be R73.03 (Prediabetes). The list of 2017 ICD-10-CM codes is not yet final, but readers can
catch an early peek at it at the CDC FTP site here.
If the patients A1c is greater than 6.5 and the glucose tolerance test and fasting blood glucose meet the
above-listed parameters for diagnosis of diabetes mellitus, your provider will probably say the patient
has overt diabetes. There are multiple ICD-10-CM coding options for diabetes mellitus, so your
providers documentation will rule your choice here, but assuming there are no complications and no
insulin use, youd report E11 (Type 2 diabetes mellitus without complications). Note that E11 isnt a
code itself; reporting this requires additional characters.

New CPT Category III Code for Diabetes Prevention

The concept of preventing diabetes is built into the Affordable Care Act, and CPT 2016 embraced this
new paradigm of delivery with a new Category III code for diabetes prevention. Youll report 0403T
(Preventive behavior change, intensive program of prevention of diabetes using a standardized diabetes
prevention program curriculum, provided to individuals in a group setting, minimum 60 minutes, per
day) for educational programs provided by nonphysician educators for situations where someone
doesnt have a diagnosis of the disease but has prediabetes or a propensity for developing diabetes. This
prevention program cant be used for people who already have diabetes, but rather for people at risk of
developing this condition. According to the AMA, these educational efforts were given a Category III
code to allow tracking of the courses success in preventing diabetes in at-risk populations. This
procedure requires a standardized curriculum recognized by CDC, taught by community-based peer led
groups.

How About You?

Have you had any personal or patient experience with diabetes prevention measures such as lifestyle
changes and especially these new CDC-recognized courses? Contact us for free trial!

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com