The Dietitian’s Ultimate Guide to ICD-10 Codes

May 21, 2024

Imagine you’re shopping at a new grocery store. When you go to check out your weekly haul, the cashier doesn’t scan each item to tally up the bill. Instead, she just eyeballs the things you’ve laid out and says you owe $350. 

Hard pass, right?

You wouldn’t be willing to pay a bill tallied this way because you want to know the exact value of each item you’ve chosen to buy. Fair enough. Insurance payers feel the same way, which is why they rely on ICD-10 (International Classification of Disease) codes to tell them the most detailed story.

ICD-10 codes are like unique price tags attached to the services you provide as a dietitian. They give insurance companies precise information on the type of care you’ve delivered by communicating details about the patient’s diagnosis. By choosing the right codes and attaching them to your services, you increase your chances of getting paid the right amount for your expertise and services — quickly and without any headaches.  

Clearing the fog about ICD-10 codes

Navigating the world of ICD-10 codes might feel confusing at first. In this article, we’ll break down some of the top questions dietitians (and nutritionists, and other professionals where regulated) ask when it comes to navigating the coding system:

  • What are ICD-10 codes and why do they matter? 
  • How do ICD-10 codes differ from ICD-10-CM codes?
  • Are CPT codes the same as ICD codes?
  • How do I manage an ICD-10-CM code practice? 
  • Where can I find the right ICD-10 codes? 

Let’s demystify ICD-10 codes together. It’s time.

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Understanding ICD-10 codes

ICD-10 codes are a standardized system developed by the World Health Organization (WHO). These codes are used worldwide to classify and diagnose health conditions. 

US healthcare providers use a slightly different version of these codes, referred to as ICD-10 Clinical Modification, or ICD-10-CM for short:

  • Clinical modification codes were authorized by the WHO and developed by the Centers for Disease Control and Prevention (CDC).
  •  ICD-10-CM codes document diagnoses associated with services rendered.
  • Implementing a proven ICD-10-CM code practice allows you to provide clinical detail essential for healthcare billing, insurance claims, and comprehensive medical documentation within the U.S. medical coding system.

Out in the wild, you’re likely to see both flavors of ICD codes referred to simply as “ICD-10 codes” or “ICD codes.” For the sake of simplicity, we will follow a similar convention in this article. 

The distinction between ICD codes and CPT codes

In medical billing and reimbursement ICD-10 codes are distinct from Current Procedural Terminology, or CPT codes. ICD codes focus on diagnoses, conditions, and reasons for seeking care whereas CPT codes describe specific procedures and services.

Here are a few ways the two codes differ for dietitians:

  • You would only record one CPT code per client visit, but it’s possible to use multiple ICD-10 codes for the same visit. 
  • Payers typically set reimbursement rates for CPT codes and they can vary depending on location, the client’s insurance plan, and more. ICD-10 codes do not directly impact reimbursement rates (but insurance companies will use them to assess the necessity of a procedure, which can ultimately affect reimbursement).

When to use ICD-10 codes and how to get them

As stated earlier, you need to include ICD-10 codes on both CMS-1500 forms when billing insurance companies directly and on any Superbills you provide directly to patients.

ICD-10 codes are diagnosis codes. It’s out-of-scope for dietitians to make a medical diagnosis so the most direct way to get the right code for a client you’re working with is from their referring healthcare provider. 

If a client comes directly to you without a referral, and you believe they have a medical condition that requires dietary intervention, you can reach out to the primary care physician to request a referral that includes the correct ICD-10 code. 

When it comes to how to find ICD codes, there are a few different ways. Here are some common ones: 

  • ICD10.Data.com offers a free medical coding reference you can use to search the entire database of ICD-10 codes.
  • American Academy of Professional Coders (AAPC) also offers an online tool called Codify by AAPC. You can search using keywords, codes, or code ranges. 
  • The CDC also has a free ICD-10 code lookup tool you can use to find relevant codes using keywords or numerical values. 
Image of the top portion of the CDC ICD-10-CM Lookup Tool with arrows pointing to two fields where you can enter a search term or the actual ICD code.
The CDC ICD-10-CM Lookup Tool can look up the diagnosis to find the code, or the code to find the diagnosis.

Now let’s explore some common ICD codes used by dietitians. 

ICD-10 code for obesity

Dietitians are critical partners in providing interventions and therapies for people living with obesity. Including an ICD-10 code for obesity on insurance claims justifies the medical necessity of your dietary counseling or therapy. 

The main ICD-10 code for obesity is E66 – Overweight and obesity. Additional numeric codes are added to this root to provide richer context on the factors contributing to the obesity: 

  • E66.0 Obesity due to excess calories
    •  E66.01 Morbid (severe) obesity due to excess calories
    •  E66.09 Other obesity due to excess calories
  •  E66.1 Drug-induced obesity
  •  E66.2 Morbid (severe) obesity with alveolar hypoventilation
  •  E66.3 Overweight
  •  E66.8 Other obesity
  •  E66.9 Obesity, unspecified

Dietitians often record both obesity and Body Mass Index (BMI) ICD-10 codes. BMI codes fall in the Z68 range and provide further quantitative information about a client’s health which can help strengthen the case for reimbursement. Note that BMI adult codes are for people 20 years of age or older, whereas BMI pediatric codes are for use for people 2-19 years of age.

Tracking BMI also allows you to see changes in a client’s body composition as a result of dietary interventions and therapies. You should measure and record BMI at regular intervals since BMI-specific ICD codes may change even if the obesity code remains the same.

For example, if you documented the codes E66.09 + Z68.42 on a CMS-1500 form you would be indicating that your client is obese due to excess calories and is an adult with a BMI in the range of 45.0-49.9. 

Image of section 21 from a CMS-1500 form indicating to enter the primary ICD-10 code in field A and the secondary ICD code in field B.

Section 21 from a CMS-1500 form, where you would enter the primary ICD-10 code in field A and the secondary ICD code in field B. 

ICD-10 code for overweight

According to the WHO, a BMI over 25 is considered overweight, while a measurement over 30 is classified as obese. 

Although there’s a lot of overlap in the care dietitians provide to obese and overweight clients, obesity is a more complex disease that can adversely affect other facets of a client’s health — including cardiovascular issues, diabetes, and hypertension. 

Due to the differences between the two conditions, insurance companies have different criteria for covering interventions. For example, they may also emphasize preventive care for overweight individuals. 

The ICD-10 code for Overweight (E66.3 Overweight) is just one in the range of codes that fall under E66 blanket of Obesity. It indicates that a client’s status is overweight rather than obese (BMI of 25.0 – 29.9). Much like the codes for obesity, it can be accompanied by a Z68 code to further contextualize with BMI. 

Image of a screencap from the CDC ICD-10-CM Lookup tool with a red box around the Z codes for Body Mass Index range 25.0 - 29.9.
Using the CDC ICD-10-CM Lookup tool can help you find the Z codes for Body Mass Index range 25.0 – 29.9, for example.

ICD-10 code for dietary counseling

There are a variety of codes dietitians use for dietary counseling. Which specific ICD-10 code for dietary counseling you choose will depend on why a particular client needs your expert services. As a dietitian, you can use these codes to document and communicate the nature of the dietary counseling you’re providing.

Using the appropriate code ensures that you’re accurately tracking and billing for your services, whether that be general dietary counseling, diabetes management, or even dietary care for pregnant women.

In this section, we’ll take a look at a few codes, including the general ICD-10 code Z71.3 and these more specific codes: 

  • Diabetes Type 2 ICD-10 code (E11 – various codes)
  • ICD-10 code for type 2 diabetes mellitus with hyperglycemia (E11.65)
  • ICD-10 code for diabetes type 2 with neuropathy (E11.40)

ICD-10 code Z71.3 – Dietary Counseling and Surveillance

The ICD-10 code Z71.3 is typically reserved for preventive dietary counseling services. 

Using it ensures accurate compensation for your services, but it also helps to streamline other aspects of care:

  • It ensures your documentation follows industry standards.
  • It helps to concisely represent complex information for easier review and analysis, including reporting on a client’s care over time.  
  • It helps with continuity of care if multiple providers are involved in a client’s treatment. The codes you use translate into a common language to keep everyone aligned on a client’s condition and progress.

ICD-10-CM codes in action

Here’s how the codes might come to life for an adult female you’re treating for obesity who has a BMI of 31.0. Note the inclusion of a CPT code to also reflect the services being provided:

CPT CodePrimary ICD-10-CM CodeSecondary ICD-10-CM Code
97802 for initial assessment and intervention, individual, face-to-face with clientZ code Z71.3 to indicate dietary counselling and surveillanceZ code Z68.31 to indicate the client’s BMI.
In order to successfully bill insurance, you’ll need a CPT code for treatment plus a primary, and sometimes a secondary, ICD-10 code.

Diabetes type 2 ICD-10 code

According to the CDC, more than 37 million Americans suffer from diabetes, and approximately 90-95% of them have type 2 diabetes. Since a person diagnosed with type 2 diabetes needs to be an active participant in managing their condition, dietitians often play a critical role in counseling clients on nutritional and lifestyle interventions. 

The umbrella diabetes type 2 ICD-10 code is E11. However, there are more codes underneath E11 containing a greater level of detail. When choosing codes for reimbursement, the most granular code that maps to the health condition you’re treating will help to justify the need for your services. 

Image of a screencap from the  CDC ICD-10-CM Lookup Tool showing the ICD-10 codes that fall under E11.
CDC ICD-10-CM Lookup Tool showing the ICD-10 codes that fall under E11.

ICD-10 code for type 2 diabetes mellitus with hyperglycemia

An example of a more granular code is E11.65, which is the ICD-10 code for type 2 diabetes mellitus with hyperglycemia. This code is more specific than the broader E11 code discussed above because it not only indicates that the client has Type 2 diabetes but also specifies that the client has elevated blood glucose levels or hyperglycemia. This provides more information about the patient’s current condition to insurance payers.

The goal when working with a client who has type 2 diabetes with hyperglycemia is to help them achieve better control over blood sugar and reduce the risk of further health complications. This means interventions associated with the ICD-10 code for type 2 diabetes mellitus with hyperglycemia could include the following: 

  • Educating the client on the importance of blood sugar control – including the role of exercise..
  • Providing meal planning with a focus on balancing carbohydrate intake, choosing low glycemic index foods, and including high-fiber foods for blood sugar stabilization.
  • Addressing emotional and behavioral factors related to eating and providing strategies to avoid emotional eating or overeating.
  • Collaborating with the client’s extended healthcare team, including physicians and diabetes educators, to ensure comprehensive and coordinated care.

ICD-10 code for diabetes type 2 with neuropathy

There are a few different ICD-10 codes associated with diabetic neuropathy. The presence of neuropathy indicates an increased risk of complications that need to be taken into account with planning dietary strategies. 

Image of a screencap from the CDC ICD-10-CM Lookup Tool  showing a few of the ICD-10 codes that fall under E11.4, including E11.40, E11.41, E11.42, and E11.43.
The CDC ICD-10-CM Lookup Tool showing a few of the ICD-10 codes for Type 2 diabetes with neuropathy.

E11.40 is the specific ICD-10 code for diabetes Type 2 with neuropathy, where the neuropathy is unspecified. It’s a general code used when the details about the neuropathy haven’t been provided. 

Note that “unspecified” codes are often seen as a temporary solution. When additional information becomes available, you should update the ICD-10 code for diabetes type 2 with neuropathy to a more specific code that accurately describes the patient’s condition. 

Let’s look at the distinction between mononeuropathy and polyneuropathy to better understand why this is so important: 

  • Mononeuropathy – ICD-10 Code E11.41

This code indicates that a single nerve or nerve group is affected. With diabetes, mononeuropathy often manifests as damage to a specific nerve in the extremities, such as the wrist or face. Common examples include carpal tunnel syndrome, femoral neuropathy, or cranial nerve palsies.

  • A dietitian’s role in treatment: The location and specific nerve affected by this condition can influence dietary recommendations. For instance, if a patient has carpal tunnel syndrome related to diabetes, your intervention might focus on managing inflammation through an anti-inflammatory diet and recommending supplements that have shown promise in supporting nerve health, like selenium and Vitamin C.
  • Polyneuropathy – ICD-10 Code E11.42

Polyneuropathy is a more generalized nerve disorder where multiple nerves throughout the body are affected. Diabetic polyneuropathy is a common complication characterized by nerve damage that can affect various parts of the body, particularly the extremities.

  • A dietitian’s role in treatment:  Since diabetic polyneuropathy is a more systemic condition, you would consider overall dietary strategies for blood sugar control, nerve health, and addressing potential complications like pain, tingling, or weakness in multiple areas. 

Recommendations may focus on maintaining stable blood sugar levels and optimizing nutrient intake to support nerve health throughout the body.

Master ICD-10 codes for your healthiest business

Your role as a dietitian is to provide nutrition therapy and counseling in alignment with a client’s overarching healthcare needs. ICD-10-CM codes help you properly document why they are receiving your care, justify the medical necessity of your services, and ensure proper billing, documentation, and continuity of care. 

Accuracy is key for ensuring you don’t run into snags and delays in reimbursement for your services. Staying up to date on the latest ICD-10-CM codes is important (they’re updated once per year.) 

Having the right practice management system can also help you streamline your use of codes and minimize errors through functionality like built-in insurance billing.

If you’re looking to manage your claims with confidence, check out Practice Better’s Claim.MD insurance integration. With this integration, you can claim and track submissions and collect payments, all in your EHR software. How great is that?

[Editor’s note: this post was originally posted on November 3, 2023. It has been updated for comprehensiveness and accuracy.]

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