With the implementation of the FY 2026 ICD‑10‑CM updates effective October 1, 2025, a new diagnosis code has been introduced: Type 2 Diabetes Mellitus without complications, in remission (E11.A). This code was created to reflect an increasingly common clinical scenario: patients who previously had type 2 diabetes but no longer require active diabetes management, having achieved sustained normal blood glucose levels—often through lifestyle changes, weight management, or surgery—but who remain at risk for occasional blood sugar spikes and related effects.
The new code ensures accurate diagnosis, documentation, and care planning for home-health patients in this category.
Key Documentation & Coding Guidelines
Here are the critical items home-health teams should ensure are addressed in the medical record.
- Provider documentation must explicitly state “in remission”
- The ICD‑10‑CM guidelines allow E11.A to be assigned only when the provider documents “in remission.”
- Terms like “resolved” or “controlled” are insufficient; a query should be made if documentation is unclear.
- Evidence to support remission status
- A prior documented diagnosis of type 2 diabetes.
- Lab values in the non-diabetic range (e.g., HbA1c < 6.5%) over a sustained period.
- Discontinuation of glucose-lowering medications, if applicable.
- No ongoing diabetic complications.
- Optional but helpful: documentation of how remission was achieved (lifestyle, weight loss, surgery).
- Coding implications and sequence
- Use E11.A for type 2 diabetes without complications in remission.
Do not use E11.A if the patient has complications or remains on active diabetes treatment.
E11.A replaces generic codes like E11.9 when remission is clearly documented.
- Use E11.A for type 2 diabetes without complications in remission.
- Home-health specific considerations
- Document remission status in initial and ongoing assessments and care plans.
- Track lab values, lifestyle interventions, and any relevant procedures or referrals.
- Even in remission, monitor for risk of recurrence and complications.
- Ensure functional and clinical documentation aligns with OASIS and HHVBP requirements.
Common Pitfalls
- Using E11.A when documentation only says “resolved” or “controlled.”
- Assigning E11.A while the patient is still on glucose-lowering medications.
- Applying E11.A when complications exist and are not clearly separated from remission.
- Failing to query ambiguous documentation.
Why This Matters for Home Health
- Accurate coding affects case-mix, PDGM payment, and quality reporting.
- Proper documentation supports clinical decision-making, monitoring, and patient education.
- Compliance and audits are simplified when remission status is clearly documented.
- Recognizes patients who do not need intensive management but remain at risk, allowing home-health teams to focus on monitoring and preventive care rather than unnecessary interventions.
