ICD-10-CM Diagnosis Code O24.813 - Other pre-existing diabetes mellitus in pregnancy, third trimester (original) (raw)

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Other pre-existing diabetes mellitus in pregnancy, third trimester

ICD-10-CM Code:

O24.813

ICD-10 Code for:

Oth pre-existing diabetes in pregnancy, third trimester

Is Billable?

Yes - Valid for Submission

Chronic Condition Indicator: [1]

Chronic

Code Navigator:

O24.813 is a billable diagnosis code used to specify a medical diagnosis of other pre-existing diabetes mellitus in pregnancy, third trimester. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2025 through September 30, 2026.

The code O24.813 is applicable to female patients aged 12 through 55 years inclusive. It is clinically and virtually impossible to use this code on a non-female patient outside the stated age range.

This medical diagnosis code is frequently used in OB/GYN medical specialties to designate conditions such maternal disorders related to pregnancy.

The code is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Diabetes: Hemoglobin A1c (hba1c) Poor Control (>9%).

  1. Code Information
  2. Clinical Classification
  3. Tabular List of Diseases and Injuries
  4. Code Edits
  5. Diagnostic Related Groups Mapping
  6. Convert to ICD-9 Code
  7. Quality Payment Program Measures
  8. Patient Education
  9. Other Codes Used Similar Conditions
  10. Code History

Clinical Classifications group individual ICD-10-CM diagnosis codes into broader, clinically meaningful categories. These categories help simplify complex data by organizing related conditions under common clinical themes.

They are especially useful for data analysis, reporting, and clinical decision-making. Even when diagnosis codes differ, similar conditions can be grouped together based on their clinical relevance. Each category is assigned a unique CCSR code that represents a specific clinical concept, often tied to a body system or medical specialty.

CCSR Code: END002

Inpatient Default: N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.

Outpatient Default: N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.

CCSR Code: PRG019

Inpatient Default: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.

Outpatient Default: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

The Medicare Code Editor (MCE) detects errors and inconsistencies in ICD-10-CM diagnosis coding that can affect Medicare claim validity. These Medicare code edits help medical coders and billing professionals determine when a diagnosis code is not appropriate as a principal diagnosis, does not meet coverage criteria. Use this list to verify whether a code is valid for Medicare billing and to avoid claim rejections or denials due to diagnosis coding issues.

The Medicare Code Editor detects inconsistencies in maternity cases by checking a patient's age and any diagnosis on the patient's record. The maternity code edits apply to patients age ange is 9–64 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).

Below are the ICD-9 codes that most closely match this ICD-10 code, based on the General Equivalence Mappings (GEMs). This ICD-10 to ICD-9 crosswalk tool is helpful for coders who need to reference legacy diagnosis codes for audits, historical claims, or approximate code comparisons.

ICD-9-CM: 648.01

Approximate Flag - The approximate mapping means this ICD-10 code does not have an exact ICD-9 equivalent. The matched code is the closest available option, but it may not fully capture the original diagnosis or clinical intent.

ICD-9-CM: 648.03

Approximate Flag - The approximate mapping means this ICD-10 code does not have an exact ICD-9 equivalent. The matched code is the closest available option, but it may not fully capture the original diagnosis or clinical intent.

When code O24.813 is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.

High Priority: YES

Measure Type: Intermediateoutcome

Submission Methods: Claims, Electronic Health Record, Cms Web Interface, Registry

Description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Diabetes and Pregnancy

What is diabetes?

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. A hormone called insulin helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

What is gestational diabetes?

Some people already have diabetes before they get pregnant. But others may develop diabetes during pregnancy. This type of diabetes is called gestational diabetes. It usually develops around the 24th week of pregnancy. It happens when your body can't make the extra insulin it needs during pregnancy. Researchers think gestational diabetes is caused by the hormonal changes of pregnancy, along with genetic and lifestyle factors.

Who is more likely to develop gestational diabetes?

Anyone who is pregnant could develop gestational diabetes. But you are more likely to develop it if you:

How do I know if I have gestational diabetes?

Gestational diabetes often has no symptoms. If you do have symptoms, they may be mild, such as being thirstier than normal or having to urinate (pee) more often.

If you are pregnant, you will most likely be screened for gestational diabetes between 24 and 28 weeks of pregnancy. But if you have an increased chance of developing gestational diabetes, you may be tested during your first prenatal visit. Your health care provider will use one or more blood glucose tests to check for gestational diabetes. You may have the glucose challenge test, the oral glucose tolerance test (OGTT), or both.

For these two tests, you will drink a sugary liquid and wait for an hour before your blood sample is taken. If you have an oral glucose tolerance test, you will also get your blood drawn after 2 and 3 hours.

How can diabetes affect my pregnancy?

Having diabetes during pregnancy can affect your health. For example:

Having diabetes during pregnancy can also affect the health of your developing baby:

How can I manage diabetes during pregnancy?

There are steps you can take to manage your diabetes before, during, and after pregnancy.

If you already have diabetes, the best time to control your blood glucose is before you get pregnant. High blood glucose levels can be harmful to your developing baby during the first weeks of pregnancy, even before you know you are pregnant. See your provider to help you plan for pregnancy. You can talk about how to lower the risk of health problems for you and your developing baby. You can also discuss your diet, physical activity, and which diabetes medicines are safe during pregnancy.

During your pregnancy, you will work with your provider to manage your blood glucose levels. You may be able to manage them with a healthy diet and regular physical activity. If that's not enough, then you will need to take diabetes medicines. It's also important that you:

After pregnancy, there are steps you need to take to stay healthy:

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

[Learn More in MedlinePlus]

Pregnancy if You Have Diabetes

Learn about how to take care of your diabetes before, during, and after pregnancy, so you may prevent or treat health problems before and after delivery.
[Learn More in MedlinePlus]