However, is the coding for the treatment and management of diabetes being adequately captured?
Diabetes mellitus (DM) affects over 400 million people worldwide. It is a chronic disease of inadequate control of blood levels of glucose that affects the body’s ability to turn food into energy.
Essentially, the food you eat is broken down into sugar (glucose) and released into the blood to be used as the body’s primary energy source. This increase in blood sugar causes the pancreas to release insulin, a hormone that acts like a key to enable the glucose to enter the body’s cells so it can be leveraged.
Lack of insulin or the inability of glucose to enter cells causes sugar to build up in the blood, which, over time, can lead to complications.
Diabetes has many subclassifications, but the two main types of DM are type 1 and type 2. Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is typically diagnosed in children or younger adults, though it can develop at any age. With type 2 diabetes, patients’ problems begin when the cells in their body start to not respond to insulin as well as they should. This is called insulin resistance, which causes high blood sugar levels (hyperglycemia). This is the most common type of diabetes.
As noted, people with diabetes have trouble regulating glucose. Regularly checking blood glucose levels is important. Maintaining those levels within a target range helps improve energy and mood while preventing or delaying severe health complications.
Patients with diabetes have to undergo fingers pricked with lancets to test blood sugar several times a day. These needle pricks can be painful, often resulting in less frequent testing. Out-of-control blood sugars can occur with less testing, resulting in increased hospital admissions and decreased health outcomes.
A continuous glucose monitoring system (CGM) is a compact medical system that continuously monitors blood sugar levels, essentially in real time. CGM systems enable patients with diabetes to manage their condition better. There have been tremendous technological advances made in glucose monitoring systems, representing perhaps the most significant progress made in controlling diabetes since insulin was discovered!
One example of CGM technology is the FreeStyle Libre CGM, a continuous glucose monitoring system approved by the Food and Drug Administration (FDA) and manufactured by United States Medical Supply LLC. This system can be scanned with a smartphone using an app. The patient must have a prescription from a healthcare provider; however, coverage does not include Medicare, Medicaid, or uninsured patients – it is only for commercial payers.
SugarBEAT, developed by United Kingdom (UK) biotech Nemaura Medical, is a new technology that uses a replaceable skin patch attached to a transmitter. It measures blood glucose levels non-invasively by passing a low-level electric current across the skin that draws out a sample of the interstitial fluid found just below the skin. The rechargeable transmitter sends data to the user’s phone every five minutes using Bluetooth, and the readings can be monitored using an accompanying app. SugarBEAT is not yet approved by the FDA due to delays caused by the global pandemic. Though it is not available in the U.S., it is available in the UK and throughout the Middle East. However, be on the lookout for this interesting and effective new alternative becoming available domestically!
The Dexcom G6 Continuous Glucose Monitoring (CGM) System is a popular U.S.-approved product. The Dexcom G6 System can improve the management and treatment of diabetes, as it allows the user to see their glucose numbers through a smartphone or device and receiver. The Dexcom CGM uses the continuous tracking method of monitoring glucose levels. Alarms will sound on these devices when your blood glucose has reached thresholds either too high or too low.
The Dexcom G6 is covered by most insurance plans and has a CPT code associated with it. Current evaluation and management (E&M) codes capture DexCom continuous glucose monitoring.
Below are associated CPT® and E&M codes for Dexcom:
Codes and Descriptions for CGM Services:
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified healthcare professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of the sensor, and printout of recording.
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.
Evaluation and Management (E&M) Codes and Descriptions:
For an established patient in a non-facility or office setting (appropriate code to be determined by the office.)
There are no PCS codes associated with CGM systems, as PCS codes are for Inpatient procedures. CGM devices are worn by the patient and monitored and read by the provider in digital data for outpatient use and utilize CPT codes only.
Diabetes can be a challenge for coders, regardless of whether they are an experienced coders or new to coding diabetes, even with the instructions and guidelines in ICD-10-CM and ICD-10-PCS. There are several assumed conditions in the index of ICD-10-CM. It is essential for coders to continually reference and familiarize themselves with these assumed conditions when coding records for diabetes.
Coders should utilize the ICD-10-CM guidelines for accurate selection and sequencing of diagnosis codes for diabetes. The entire Chapter 4 Endocrine, Nutritional, and Metabolic Diseases of the ICD-10-CM code book contains codes for DM. These are combination codes that include the type of diabetes and associated complications, organized by the body system affected.
It is vital for us, as healthcare workers, to properly diagnose and code for diabetes, following the guidelines and paying attention to specifics. But most importantly, patients should be aware of the advancements in glucose monitoring technologies in order to determine which system meets their needs so they can better manage their condition.
Programming Note: Listen to Susan Gatehouse report this story live today on Talk Ten Tuesdays, 10 Eastern.
Today is Mardi Gras, which is French for “Fat Tuesday.” It is the last day before lent starts tomorrow, Ash Wednesday. This got me thinking
EDITOR’S NOTE: The narrative in this article reflects the firsthand perspectives and professional experience of Tami McMasters Gomez, curated and prepared for publication by Penny
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
