ICD-10 Code for Steroid-Induced Hyperglycemia
The ICD-10 code for steroid-induced hyperglycemia is E09.65 (Drug or chemical induced diabetes mellitus with hyperglycemia), or if the patient does not meet criteria for diabetes, use R73.9 (Hyperglycemia, unspecified).
Coding Framework
The appropriate ICD-10 code depends on whether the patient meets diagnostic criteria for steroid-induced diabetes versus transient hyperglycemia:
E09.65 - Drug or Chemical Induced Diabetes Mellitus with Hyperglycemia
- Use this code when the patient has repeated glucose measurements ≥11.1 mmol/L (200 mg/dL) in the setting of steroid use AND an HbA1c ≥6.5%, which constitutes steroid-induced diabetes 1
- This applies to patients without previous history of diabetes who develop persistent hyperglycemia on steroids 1
R73.9 - Hyperglycemia, Unspecified
- Use this code for steroid-induced hyperglycemia that does not meet diabetes criteria (glucose ≥11.1 mmol/L but HbA1c <6.5% or transient elevations only) 1
- This is appropriate for mild, transient hyperglycemia that resolves with steroid discontinuation
Additional Coding Considerations
- Always add a secondary code to identify the specific steroid causing the hyperglycemia (T38.0X5A for adverse effect of glucocorticoids, initial encounter)
- For patients with pre-existing diabetes who develop worsening hyperglycemia on steroids, use their existing diabetes code (E10.65 for Type 1, E11.65 for Type 2) rather than E09.65, as this represents exacerbation of known disease rather than drug-induced diabetes 1
Diagnostic Criteria to Guide Coding
Steroid-induced diabetes requires:
- Repeated glucose measurements ≥11.1 mmol/L (200 mg/dL) 1
- HbA1c ≥6.5% 1
- No previous history of diabetes 1
- Temporal relationship with steroid use 1
Steroid-induced hyperglycemia (without diabetes) involves:
- Glucose elevations ≥11.1 mmol/L but HbA1c <6.5%, OR 1
- Transient hyperglycemia that normalizes with steroid discontinuation 2
Common Coding Pitfalls to Avoid
- Do not use E09.65 for patients with pre-existing diabetes who develop worsening hyperglycemia on steroids—this is an exacerbation of their underlying diabetes, not drug-induced diabetes 1
- Do not rely on fasting glucose alone for diagnosis, as steroid-induced hyperglycemia peaks 6-9 hours after morning steroid administration and may normalize overnight, leading to underdiagnosis 3, 4, 2
- Ensure HbA1c is checked before assigning E09.65, as glucose elevations alone without HbA1c ≥6.5% do not meet diabetes criteria 1
- Document the specific steroid and dose in the medical record to support the diagnosis and coding 5