ICD-10 Code for Ozempic (Semaglutide) in Type 2 Diabetes
Use ICD-10 code E11.9 (Type 2 diabetes mellitus without complications) as the primary diagnosis code for patients prescribed Ozempic (semaglutide), or use more specific E11.x codes if complications are present.
Primary Diagnosis Codes
- E11.9 is the most appropriate code for uncomplicated type 2 diabetes when prescribing Ozempic 1
- If the patient has established cardiovascular disease, use E11.65 (Type 2 diabetes mellitus with hyperglycemia) combined with the appropriate cardiovascular disease code, as Ozempic has proven cardiovascular benefits in this population 2
- For patients with diabetic kidney disease, use E11.22 (Type 2 diabetes mellitus with diabetic chronic kidney disease) to reflect the renoprotective indication 3
Complication-Specific Codes
When complications are present, select the appropriate E11.x code that reflects the patient's condition:
- E11.21: Type 2 diabetes with diabetic nephropathy (for patients with proteinuria or reduced eGFR) 3
- E11.22: Type 2 diabetes with diabetic chronic kidney disease (for established CKD) 2
- E11.51: Type 2 diabetes with diabetic peripheral angiopathy without gangrene 1
- E11.65: Type 2 diabetes with hyperglycemia (when HbA1c is elevated above target) 4
Additional Supporting Codes
For cardiovascular indications, add secondary diagnosis codes to support medical necessity:
- I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris 2
- I50.9: Heart failure, unspecified (if heart failure is present) 2
- Z86.73: Personal history of transient ischemic attack (TIA) and cerebral infarction without residual deficits 2
For obesity management, which is relevant given Ozempic's weight loss effects:
- E66.01: Morbid (severe) obesity due to excess calories (BMI ≥40) 4, 5
- E66.9: Obesity, unspecified (BMI 30-39.9) 4, 5
Clinical Context for Code Selection
The American Diabetes Association guidelines establish that semaglutide (Ozempic) is indicated for patients with type 2 diabetes who have established atherosclerotic cardiovascular disease or are at high cardiovascular risk 2. The SUSTAIN-6 trial demonstrated a 26% reduction in major adverse cardiovascular events (HR 0.74,95% CI 0.58-0.95) 2.
For renal protection, recent evidence shows significant renoprotective effects, with one case report demonstrating reduction in urine albumin-to-creatinine ratio from 267 mg/g to 34 mg/g over 12 months 3. This supports using diabetic nephropathy codes (E11.21 or E11.22) when kidney involvement is present.
Important Documentation Requirements
- Document baseline HbA1c (typically ≥7.0% for initiation) 4, 6
- Record BMI if obesity is a treatment consideration (mean BMI in trials was 38.6 kg/m²) 4
- Note cardiovascular disease status, as this strengthens medical necessity 2
- Document failure or contraindication to metformin if applicable 2
Common Pitfalls to Avoid
- Do not use E10.x codes (Type 1 diabetes codes) for patients on Ozempic, as it is not indicated for type 1 diabetes 1, 6
- Avoid using only E11.9 when specific complications exist, as more specific codes better reflect medical necessity and the patient's condition 1
- Do not forget secondary diagnosis codes for cardiovascular disease or obesity when these are treatment indications, as they support prior authorization requirements 2