With the release of new October 1 codes, coders noted some areas where they were hoping for some additional guidance or clarification.
With the release of Coding Clinic 4th quarter 2025 we now have some. One of them is the new E11.A code assigned from Diabetes type 2, without complications in remission.
Coding Clinic does give a definition noting in remission is noted when a patient achieves an A1C level of less than 6.5 percent for at least three months after stopping all glucose lowering medications. It goes on to note that weight loss and lifestyle changes can also cause remission. Coding Clinic does reference improvements in bariatric surgery and new antidiabetic medications as causes for a rise in cases of Type 2 diabetes in remission.
How long a patient remains in remission is dependent on the individual patient, with remission possibly lasting months to years. Coding Clinic does caution that relapses can occur when patients no longer follow dietary restrictions or decrease their physical activity.
As expected, Coding Clinic echoes the guideline update 4.a.1.b. noting in remission must be documented by the provider and when it is unclear, the provider should be queried. It also lists term “history of T2DM” in addition to “resolved T2DM” as not synonymous with diabetes Type 2 in remission. Lastly it notes that E11.A should not be reported when the patient has any diabetic complications as the code description suggests.
There are two questions posed which Coding Clinic does answer. The first notes a case where a patient has Type 2 diabetic chronic kidney disease in stage 2. This patient also had bariatric surgery in the past for their morbid obesity.
Now the patient has lost weight and no longer is needing any antidiabetic medication. Questioner notes that the provider documents diabetes in remission and stable CKD. Specific question posed here is it appropriate to assign for diabetes in remission in this case.
In their response, Coding Clinic references the Excludes 1 note at E11.A which notes that codes for Type 2 diabetes with complications, here the CKD, can’t be assigned with E11.A. So, it is not appropriate to assign diabetes in remission in this case. Rather the diabetes with chronic kidney disease, the stage 2 CKD and personal history of bariatric surgery codes would be assigned.
The second question is very straightforward. Patient has Type 2 diabetes with again a history of bariatric surgery due to morbid obesity. Again, here the patient lost a lot of weight and is no longer taking antidiabetic meds.
More importantly, the provider documents the diabetes is in remission. Here we would assign the E11.A for diabetes in remission, also adding the personal history of bariatric surgery as an additional code.
If you haven’t already reviewed the 4th quarter edition of Coding Clinic, I encourage you to do so.
Make sure you and your coding team are up to date on the latest guidance and clarifications.
EDITOR’S NOTE: The author of this article used AI-assisted tools in its composition, but all content, analysis, and conclusions were based on the author’s professional
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