Understanding ICD-10-CM Code E11.9 – Type 2
Diabetes Mellitus Without Complications (2025 Edition)

 

ICD-10-CM code E11.9 remains unchanged for the 2025 fiscal year. This code is used to classify and report Type 2 diabetes mellitus without complications, a condition prevalent in adult populations worldwide.

 

Understanding ICD-10-CM Code E11.9 – Type 2 Diabetes Mellitus Without Complications (2025 Edition)

🔍 ICD-10-CM Code Overview: E11.9

• Code: E11.9
• Description: Type 2 diabetes mellitus without complications
• Billable: Yes – code is valid for submission on medical claims
• Effective Date: October 1, 2024
• Version: 2025 ICD-10-CM

 
🏥 Key Coding Guidelines

• E11.9 is a billable/specific ICD-10-CM diagnosis code, which means it can be used for reimbursement purposes.
• However, E11.9 alone is not typically considered sufficient justification for admission to an acute care hospital if used as the principal diagnosis. It must usually be accompanied by a complication, comorbidity, or another acute issue.
• This code falls under Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00–E89), specifically within Type 2 Diabetes Mellitus (E11).

 

📑 Common Clinical Scenarios Represented by E11.9

Healthcare providers may use this code when a patient:

• Has Type 2 diabetes controlled with diet or oral medications
• Is on insulin but without any documented complications
• Requires routine diabetic management visits
• Undergoes nutritional therapy or diabetes education
• Receives a diabetic foot exam as preventive care

 

🧠 Common Synonyms/Clinical Terms for E11.9

These may appear in medical records and map to E11.9:

• Type 2 diabetes mellitus (T2DM)
• Diabetes mellitus type 2, uncomplicated
• Diabetes type 2, controlled by diet
• Diabetes in postpartum (without complication)
• Insulin-treated non-insulin-dependent diabetes mellitus
• Maturity-onset diabetes of the young (MODY)

 

📊 MS-DRG Groupings (Medicare Severity Diagnosis-Related Groups)

Depending on the case complexity and associated conditions, E11.9 may fall under one of the following MS-DRG codes (v42.0):

·         637 – Diabetes with Major Complication/Comorbidity (MCC)

·         638 – Diabetes with Complication/Comorbidity (CC)

·         639 – Diabetes without CC/MCC

 

🔁 ICD-9-CM Crosswalk

For legacy reference, E11.9 corresponds to the former ICD-9-CM code 250.00 – Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled.

 

🗂️ Coding Tip for Medical Billers and Coders

Always ensure that documentation clearly states that the patient has no complications. If any complication (e.g., neuropathy, nephropathy, or retinopathy) is noted, coders must assign a more specific subcategory under E11. Avoid undercoding or overcoding by accurately reviewing the provider's documentation and related labs, referrals, or prescriptions (e.g., insulin use).

 

⚠️ When Not to Use E11.9 Alone

Do not use E11.9 as the sole diagnosis code when:

·         The patient is admitted for an acute diabetic-related complication (e.g., ketoacidosis, hypoglycemia)

·         There is evidence of diabetic complications such as nephropathy, retinopathy, or foot ulcers

·         The diagnosis is related to gestational or Type 1 diabetes

 

📅 Code History (No Changes from 2016–2025)

• Introduced in ICD-10-CM: 2016 (effective 10/1/2015)
• No updates or changes through 2025
• Continued use indicates clinical stability and consistency in documentation standards for uncomplicated Type 2 diabetes

 

ICD-10-CM Code E11.9 serves as a foundational diagnosis in outpatient care and chronic disease management. Proper documentation, coding specificity, and recognition of any comorbidities or complications are essential for accurate reimbursement, quality reporting, and risk adjustment.