On October 1st, the T1D community got a big win: the Centers for Medicare and Medicaid Servies (CMS) introduced a unique ICD-10 code for stage 2 type 1 diabetes (T1D). This addresses a significant gap in clinical care. Prior to this change, clinicians had limited options for coding stage 2 T1D, which resulted in inaccurate patient records.
This may seem like a minor detail but it’s critical! It will profoundly affect physicians’ abilities to diagnose and treat people with stage 2 T1D.
What is an ICD-10 Code?
ICD-10 codes are codes used by healthcare providers to classify and document diagnoses, symptoms, and procedures. These codes provide a unified way for doctors and providers to indicate what diseases or conditions a person has in their electronic health record (EHR).
The ICD-10 code for stage 3 T1D, or clinical diagnosis of T1D is E10. If that code is in a person’s EHR, a physician immediately knows that they have T1D. Having that information can help them provide proper care to their patients.
What Is Stage 2 T1D?
Stage 2 T1D is defined by the presence of autoimmune antibodies (AAB). Autoantibodies are proteins in the blood that indicate the body’s immune system is attacking the insulin-producing cells in the pancreas. People in stage 2 are usually asymptomatic, but they can experience dysglycemia, or abnormal blood sugar levels.
The only way individuals can find out if they are in stage 2 T1D is through antibody screening.
Why does this matter?
Stage 2 and stage 3 T1D are not the same. They are not managed in the same way or treated in the same way. For a healthcare provider to give the appropriate care, they need the correct diagnosis.
The previous lack of an ICD-10 code for this early stage of T1D meant that individuals could be misclassified, either reflecting stage 3 T1D or no T1D at all. This means they may not be getting the proper care and monitoring of the disease’s potential progression.
Here’s how this changes T1D management:
The introduction of a specific code for stage 2 T1D has significant implications.
Enhanced monitoring and education
- Recognizing individuals in stage 2 allows healthcare providers to deliver the right education on monitoring so they can prepare for stage 3. This can eliminate diabetic ketoacidosis, a life-threatening condition that can occur at diagnosis.
Access to new therapies
- Individuals diagnosed in stage 2 may be eligible for an FDA-approved disease-modifying therapy that delays onset of stage 3 for an average of two years.
Research opportunities
- Many recruiting clinical trials are available for people with stage 2 and 3 T1D. If individuals are coded correctly, they can better take advantage of these studies and play a crucial role in developing the next generation of T1D therapies.
Evidence-based care
- Accurate coding ensures that healthcare providers can deliver evidence-based clinical care. If a diagnosis is not documented correctly, it may result in missed opportunities for intervention and support.
How this happened
Breakthrough T1D played a significant role in advocating for the creation and adoption of this code. We crafted a letter in support of this code that several of our peer organizations signed onto. We also galvanized the clinical side to add their support to this initiative, all of which were instrumental in the code creation and adoption.
A big step forward
The recent introduction of ICD-10 codes for Stage 2 T1D is a significant step forward for the T1D community. By accurately identifying individuals at this critical stage of T1D, healthcare providers can treat and monitor them accordingly, improving both patient outcomes and enhancing our understanding and management of T1D.
