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), and you must always add a secondary code T38.0X5A to identify the specific glucocorticoid causing the adverse effect. 1
Critical Coding Requirements
Always use both codes together: 1
- Primary code: E09.65 (drug or chemical induced diabetes mellitus with hyperglycemia)
- Secondary code: T38.0X5A (adverse effect of glucocorticoids, initial encounter)
Key Diagnostic Criteria Before Coding E09.65
You cannot assign E09.65 based on glucose elevations alone. The American Diabetes Association requires specific criteria: 1
- Repeated glucose measurements ≥11.1 mmol/L (200 mg/dL) AND HbA1c ≥6.5% 1
- Temporal relationship to steroid use must be documented 1
If glucose is elevated but HbA1c <6.5%, or if hyperglycemia normalizes with steroid discontinuation, this represents steroid-induced hyperglycemia without diabetes and does not meet criteria for E09.65. 1
Critical Pitfall: Pre-Existing Diabetes
Do NOT use E09.65 for patients with pre-existing diabetes who develop worsening hyperglycemia on steroids. 1 This is a common coding error that misrepresents the clinical situation.
For patients with known diabetes experiencing steroid-induced worsening: 1
- Type 1 diabetes: Use E10.65 (Type 1 diabetes mellitus with hyperglycemia)
- Type 2 diabetes: Use E11.65 (Type 2 diabetes mellitus with hyperglycemia)
The rationale is that this represents exacerbation of their underlying disease, not drug-induced diabetes. 1
Essential Pre-Coding Checklist
Before assigning E09.65, verify: 1
- HbA1c has been checked and is ≥6.5% (glucose elevations alone are insufficient)
- No history of pre-existing diabetes (if present, use their existing diabetes code instead)
- Clear temporal relationship to steroid initiation
- Secondary code T38.0X5A is added to identify the causative agent