Q&A: Proper use of new diabetes code for cases in remission

Q: When is it appropriate to report new ICD-10-CM code E11.A for Type 2 diabetes mellitus without complications in remission?

A: ICD-10-CM code E11.A (effective October 1, 2025) can be assigned to identify people with Type 2 diabetes that have reached remission status. There are new guidelines that give us some specific details about what is considered in remission in terms of provider documentation. Coders cannot assign the code without the physician stating that diabetes is in remission because there are clinical standards for when remission can be diagnosed. Just because the patient has had stable A1C levels for a period of time does not mean it is diagnostic criteria for the physician. It is only going to be in remission if coders see the physician using the term in remission. If the documentation is unclear as to whether the Type 2 diabetes has achieved remission, the provider should be queried.

The most important tip for correct code use is to carefully review documentation, as terms other than “remission” are not acceptable. For example, the term “resolved” is not synonymous with “remission.” This makes sense because resolved means the condition is gone and not a problem anymore. Remission means the patient has a condition that is currently under control. A patient can be in remission with diabetes, just like a patient can be in remission with cancer, and still be taking some kind of medication, especially with GLP-1 medications that allow patients to maintain their weight loss or A1C stability. Ultimately, coders can't take the term resolved and assume that the condition is in remission. If anything is not clear regarding remission status, ask the physician. It is better to only use this code when it is very clear that the diabetes is in remission.

If a patient has manifestations documented by the provider as associated with diabetes, the guidelines have not changed in terms of assuming connections between manifestations and diabetes. Take a patient who has diabetes and peripheral neuropathy. Unless the physician says the neuropathy is related to something else, coders would presume the two conditions to be related. That doesn't mean you can't query the physician if there is something in the documentation that leads you to believe that the peripheral neuropathy (or other conditions) may not be related to the diabetes.

However, if a patient does have manifestations that are presumed to be associated with diabetes in remission and the physician specifically states the conditions are associated with diabetes, coders will not use E11.A even if the patient clearly has a diagnosis of diabetes in remission at that time. The reason for this is because the code is specific to Type 2 diabetes without complications in remission. If the patient has any complications, coders should not assign E11.A even though there are no combination codes for diabetes in remission with any associated conditions that can be used as an alternative.

Remember that code E11.A only applies to Type 2 diabetes, which is also the default unspecified code for diabetes. This is not an appropriate code if patients have Type 1 diabetes, autoimmune diabetes, diabetes due to an underlying cause, or diabetes due to drugs or medications, even if documentation clearly states that the diabetes is in remission.

Editor’s note: This Q&A originally appeared in JustCoding and was excerpted from the DecisionHealth webinar, “2026 ICD-10 Code Changes: Get Tips for Correct Code Use.”