E11.65
BillableType 2 diabetes mellitus with hyperglycemia
HCC Category Mapping
V28HCC 38 — Diabetes without Complication
0.450V24HCC 18 — Diabetes with Chronic Complications
0.302ESRDHCC 18 — Diabetes with Chronic Complications
0.000RxHCCHCC 30 — Diabetes with Complications
0.000What This Code Means
Type 2 diabetes with abnormally high blood sugar levels that are not controlled by current treatment.
Coding Tips
- •Document the specific blood glucose readings or HbA1c values to support hyperglycemia diagnosis
- •Distinguish from uncontrolled diabetes by confirming elevated glucose levels are present
Clinical Significance
Type 2 diabetes mellitus with hyperglycemia indicates persistently elevated blood glucose that is inadequately controlled by current therapy, including oral medications, non-insulin injectables, or insulin. Chronic hyperglycemia drives the development and progression of all microvascular and macrovascular diabetic complications. This code signals the need for treatment intensification through medication adjustment, lifestyle modification, or specialist referral.
Documentation Requirements
- ✓The provider must document hyperglycemia in the context of Type 2 diabetes, including specific blood glucose readings or hemoglobin A1c values demonstrating inadequate control.
- ✓Current medication regimen, adherence assessment, and planned therapeutic changes should be recorded.
- ✓The documentation should distinguish hyperglycemia from diabetic ketoacidosis or hyperosmolar state, which are more severe conditions.
Commonly Confused Codes
E11.00/E11.01 (hyperosmolarity) and E11.10/E11.11 (ketoacidosis) represent more severe metabolic decompensation and should be used when those criteria are met.E11.9 (without complications) is used when no complications including hyperglycemia are documented.E11.649 (hypoglycemia) is the opposite metabolic derangement.Z79.84 (long-term use of oral hypoglycemic drugs) is a status code, not a complication code.
Code Hierarchy
└E11Type 2 diabetes mellitus└E11.6Type 2 diabetes mellitus with other specified complications└E11.65Type 2 diabetes mellitus with hyperglycemia
└E11.65Type 2 diabetes mellitus with hyperglycemia