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1/14/2026

Diabetes Coding Updates

By Dawnelle Sager

Over the past two years, ICD-10-CM has introduced several important code updates and additions related to diabetes. In fiscal year (FY) 2025 (effective October 1, 2024), new codes were established to capture presymptomatic Type 1 diabetes under subcategory E10.Ax (Type 1 diabetes mellitus, presymptomatic). In FY 2026 (effective October 1,  2025), ICD-10-CM introduced a new subcategory and accompanying guidelines for Type 2 diabetes in remission under E11.A (Type 2 diabetes mellitus without complications in remission).

These updates allow for more precise reporting of diabetes stage and status, supporting improved data capture and clinical understanding. Below is  a closer look at each update and key coding considerations.

Pre-Symptomatic Type 1 Diabetes (T1DM)

A new ICD-10-CM subcategory was added to clearly capture the stages of presymptomatic Type 1 diabetes.  Prior to the introduction of these codes, coders often relied on one code for “pre-diabetes”, R73.03, which does not distinguish between diabetes types.  An international group of endocrinologists and diabetes experts submitted a formal request for new codes to identify early-stage, presymptomatic Type 1 diabetes.

Type 1 diabetes develops through a prolonged autoimmune process in which pancreatic beta cells are destroyed, often long before clinical symptoms appear. This autoimmune activity predicts a very high likelihood of progression to Type 1 diabetes. Early identification of presymptomatic Type 1 diabetes supports improved long-term outcomes including lower rates of diabetic ketoacidosis, earlier patient education and support (prior to onset of insulin initiation) and eligibility for FDA-approved therapies that may delay the need for insulin therapy.

With October 1, 2024, ICD-10-CM updates, a new subcategory was introduced:

  • A – Type 1 diabetes mellitus, presymptomatic
    • A0 – Type 1 diabetes mellitus, presymptomatic, unspecified
    • A1 – Type 1 diabetes mellitus, presymptomatic, Stage 1
      • Patients do not have any glucose abnormalities or symptoms.
    • A2 – Type 1 diabetes mellitus, presymptomatic, Stage 2
      • Evidence of glucose abnormalities is present but no symptoms at this stage.

Stage 3 represents the clinical diagnosis of Type 1 diabetes based on diagnostic criteria and the presence of symptoms and should be coded using the appropriate E10 code.

When assigning these codes, coders must carefully review the Excludes 1 notes, which indicate the two codes cannot be reported together.

Type 2 Diabetes (T2DM) in Remission

In FY 2026, ICD-10-CM introduced new guidelines and a new subcategory code to identify patients with Type 2 diabetes in remission:

  • A, Type 2 diabetes mellitus without complications in remission.

This concept was first discussed during the March 2024 ICD-10 Coordination and Maintenance Committee Meeting. Prior to its introduction, ICD-10-CM lacked a mechanism to represent remission of Type 2 diabetes, resulting in coding inconsistencies.

During committee discussions, several terms were evaluated to describe “disease-free”, including resolution, reversal, remission and cure. The term “remission” was selected as most appropriate because the condition may recur over time and not necessarily be permanently resolved.

According to the American Diabetes Association and other professional organizations, remission is defined as maintaining an average blood glucose level (HbA1C) below 6.5 for at least three months following cessation of glucose lowering medications. While weight loss and lifestyle modifications can significantly improve Type 2 diabetes, patients remain at increased risk for recurrence. Remission may last months or years depending on the individual, with relapse potentially occurring if a healthy weight is not maintained.  Patients with diabetes-related complications are less likely to achieve remission.

Coding Considerations

The code description specifies “without complications, in remission”.  If a patient has manifestations or complications commonly associated with diabetes (i.e., retinopathy or neuropathy), E11.A code should not be assigned unless the provider documentation clearly states the condition is unrelated to diabetes. Standard ICD-10-CM guidelines continue to apply, including the presumption of a relationship between diabetes and associated conditions unless documentation specifies otherwise. This code is not assigned for patients with Type 1 diabetes.

Documentation Requirements

Clear and specific documentation is required to support assignment of E11.A.  The provider must explicitly document the term “remission”. Phrases such as “history of Type 2 diabetes” or “resolved Type 2 diabetes” are not synonymous with “remission”.  When such terminology is used, the provider should be queried for clarification prior to code assignment.

Additionally, the patient should not be using insulin or oral hypoglycemic medications, as remission requires sustained normoglycemia without glucose-lowering therapy.  As with all diagnoses, codes may not be assigned based solely on laboratory values without documented provider confirmation.

Conclusion

While ICD-10-CM codes are reported primarily on claims, rather than directing clinical care, the added specificity introduced by these updates supports clearer documentation and more accurate representation of disease stage and status. This allows organizations to better identify patient populations, evaluate outcomes, and align education, monitoring, and preventive strategies at the system level. Ultimately, these coding updates help support proactive, data-driven approaches to diabetes management and long-term care planning.

For questions and more information, please contact our experts at Pinnacle Healthcare Consulting today.

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Dawnelle Sager
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