Diabetes mellitus (DM) is the most common disease endocrinologists treat. A chronic metabolic condition, DM is characterized by high blood glucose levels (hyperglycemia). An estimated 40.1 million Americans have diagnosed or undiagnosed diabetes, according to the Centers for Disease Control and Prevention (CDC).
According to the American Diabetes Association (ADA), skin complications can be the initial warning sign of high blood sugar levels in people who remain undiagnosed. Researchers have found that certain skin disorders are more common in type 1 diabetes, while others occur more frequently in individuals with type 2 diabetes. While most diabetes-related skin complications are harmless, some can result in painful and persistent symptoms that require medical attention.
This post focuses on six common diabetes-related skin disorders and their ICD-10 codes. It also discusses the increasingly important role of endocrinology medical billing and coding services in ensuring accurate code assignment, compliant claim submission, and optimal reimbursement.
Improve coding accuracy and streamline reimbursement with smarter, AI-powered coding support.
Why Diabetes Increases the Risk of Skin Disorders
People with high blood sugar often develop skin disorders. Prolonged diabetes impairs the white blood cells that protect the immune system, damages small blood vessels, and alters nerve function. These diabetic complications reduce the skin’s ability to heal and fight off bacteria.
The reasons why chronic hyperglycemia increase risk of skin conditions are:
- Compromised Immune Function: By impairing white blood cells, high glucose levels increase the risk of bacterial and fungal skin infections.
- Poor Blood Circulation: By damaging small blood vessels, elevated blood sugar results in poor circulation. When delivery of oxygen and nutrients to the skin is restricted, it slows down the healing process for even minor cuts and scrapes.
- Neuropathy: When a person develops diabetic nerve damage or neuropathy, they can lose sensation in the extremities, meaning they do not feel blisters, cuts, or sores. When these conditions go unnoticed, they progress into serious ulcers.
- Skin Protein Alteration (Glycation): High blood sugar leads to the formation of advanced glycation end-products (AGEs). This damages collagen, making the skin stiff, less elastic, and more prone to cracking or blistering.
Let’s take a look at the ICD-10 codes for common diabetes-related skin disorders.
Six Diabetes-Related Skin Disorders and Their ICD-10 Codes
- Acanthosis nigricans
- L83 – Acanthosis nigricans
A skin condition commonly associated with insulin resistance and type 2 diabetes, acanthosis nigricans is characterized by dark, thickened, velvety patches of skin that typically develop in body folds and creases. The condition affects skin in areas such as the neck, armpits, groin, elbows, knees, knuckles, and palms. While not a disease itself, acanthosis nigricans are often a warning sign of an underlying metabolic disorder. The condition is more common in individuals who are overweight or obese. Management focuses on treating the underlying cause, such as improving blood sugar control and addressing insulin resistance. Weight loss may help reduce the appearance of the affected skin. Medication-related cases may improve if the causative drug is discontinued or replaced under medical supervision.
The ICD-10 code for this skin condition is:
- Vitiligo
- L80 – Vitiligo
Vitiligo is a chronic skin condition that causes the loss of pigmentation, resulting in lighter or white patches on the skin. It occurs when melanocytes, the cells responsible for producing melanin, are destroyed or stop functioning. Although vitiligo can affect people of all skin tones, the contrast is often more noticeable in individuals with darker skin. The condition commonly appears on sun-exposed areas such as the face, hands, arms, feet, and lips, but it can also affect the hair, mucous membranes, and even the eyes. Symptoms include patchy skin discoloration, premature graying or whitening of hair, and loss of color inside the mouth or nose. While there is no cure for vitiligo, treatment options such as topical medications, light therapy, and surgical procedures in selected cases may help restore some skin color and improve appearance.
The ICD-10 code to report vitiligo diagnosis is:
- Fungal Skin Infections
- B37.2 – Cutaneous candidiasis
- B37.2 – Candidiasis of skin and nail
- B35.4 – Tinea corporis (ringworm of the body)
- B35.6 – Tinea cruris (jock itch)
- B35.3 – Tinea pedis (athlete’s foot)
- B35.2 – Tinea manuum
- B35.1 – Tinea unguium (onychomycosis)
- B35.9 – Unspecified dermatophytosis
- E11.628 – Type 2 diabetes mellitus with other skin complications
- E10.628 – Type 1 diabetes mellitus with other skin complications
- E11.628 – Type 2 diabetes mellitus with other skin complications (listed first)
- B37.2 – Candidiasis of skin and nail (additional code)
Fungal skin infections are very common in people with diabetes because elevated blood glucose levels can promote fungal growth. Common infections include candidiasis, which may affect skin folds, the groin, armpits, areas under the breasts, and around the nails. Symptoms include itching, redness, rash, and white patches. Treatment typically involves antifungal medications and improved blood glucose control.
There are specific ICD-10 codes for fungal skin infections that depend on the type and location of the fungal infection. If the documentation states that the condition is caused by diabetes, assign the specific fungal infection code first, followed by a diabetes mellitus code with a “skin complication” manifestation (e.g., category E08–E13 with subcategory .628).
Coding Considerations
Identify the code for the specific fungal infection documented (e.g., B37.2 for cutaneous candidiasis).
To properly report that the infection is a complication of the patient’s diabetes, include the appropriate diabetes code, such as:
The diabetes code is generally sequenced first, followed by the code for the specific fungal infection.
For example:
- Bacterial Skin Infections
- L03.311 – Cellulitis of right trunk
- L03.312 – Cellulitis of left trunk
Individuals with diabetes have a higher risk of bacterial skin infections such as cellulitis, boils, styes, folliculitis, and infected wounds. Symptoms may include redness, swelling, warmth, pain, and drainage. Prompt treatment is important to prevent complications.
Similar to fungal infections, coding bacterial skin infections in patients with diabetes requires a combination code for the diabetes and a specific code for the infection.
Example:
Cellulitis
If cellulitis is documented, assign the ICD-10 code using the appropriate anatomical location, such as:
Pair the infection code with the specific type of diabetes complication code (E10.628 or E11.628). For complete billing compliance, list the diabetes code first followed by the skin infection code.
- Diabetic Dermopathy
- Type 1 Diabetes with Dermopathy – E10.628 (Type 1 diabetes mellitus with other skin complications
- Type 2 Diabetes with Dermopathy – E11.628 (Type 2 diabetes mellitus with other skin complications)
- Diabetic dermopathy as the complication, and
- The diabetes type (Type 1 or Type 2).
Often called “shin spots,” diabetic dermopathy is one of the most common skin manifestations of diabetes. The condition appears as light brown, scaly patches on the shins and is associated with changes in small blood vessels. The spots are painless, do not itch, and are not contagious. The best way to manage diabetic dermopathy is maintaining optimal blood sugar levels, which can slow the development of new spots.
Diabetes mellitus with dermopathy is classified under ICD-10 as a skin complication. The specific code depends on the type of diabetes and whether other skin complications are present. The ICD-10 code for dermopathy is categorized under the main diabetes diagnosis:
For diabetic dermopathy reporting, the provider’s documentation must clearly identify:
- Diabetic Blisters (bullosis diabeticorum)
- S90.82 – Blister (nonthermal) of foot
- S90.821 – Blister (nonthermal), right foot
- S90.822 – Blister (nonthermal), right foot
- S90.829 – Blister (nonthermal), unspecified foot
Diabetic blisters are usually seen in patients with poorly controlled blood sugar, commonly along with diabetic neuropathy. The blisters appear as clear, irregularly shaped bumps, usually on the legs, feet, and toes, and less often on the hands, fingers, or arms. They are typically painless and may heal on their own. Puncturing or bursting blisters can lead to infection and ulceration. Blood sugar control is the first step in treating diabetic blisters. Antibiotic creams, steroid creams, and protective bandages may be prescribed to prevent further injury.
Documentation Tips for Coding Diabetic Skin Complications
When coding for diabetic skin complications, the documentation must clearly connect the skin issue to the patient’s diabetes. Medicare and insurance companies require specific information to approve claims for diabetes-related skin disorders.
- Ensure documentation specifies diabetes type
- Specify the skin complication to ensure correct code assignment
- Clearly state the location and severity
- Document all treatments and medications
The provider must document therapy type — whether the patient is on insulin, oral agents, or injectable non-insulin drugs.
Key Guidelines for Coding Diabetes-Related Skin Disorders
For any diabetes-related skin disorder, coders must:
- Assign the correct combination diabetes code (e.g., E10.628, E11.628, E11.620).
- Add the appropriate Z79 code to indicate long-term drug therapy for diabetes control.
- Ensure correct sequencing:
- Place the diabetes code (E10–E14 series) first.
- Include the skin complication code within the combination diabetes code.
- Add the Z79 therapy code as a secondary code.
When billing for diabetes-related skin disorders, even minor coding errors can lead to immediate claim rejections, audited charts, or lost revenue. Today, AI-assisted medical coding tools help providers receive proper reimbursement more quickly.
Avoid Medical Billing Errors with AI-Powered Coding
AI medical coding services help healthcare providers ensure fast and accurate diabetes skin conditions ICD-10 coding. AI systems use smart technology like Natural Language Processing (NLP) to read a patient’s chart, catch errors, and prevent claim denials.
For example, if the provider documents “shin spots” but misses writing “due to diabetes”, an AI coding platform like MedGenX will find the gap. It will catch the patient’s history of Type 2 diabetes and suggest the correct combination code like E11.628.
Powered by DeepKnit AI, MedGenX can be adapted to each organization’s unique workflows and supports a human-in-the-loop review process, ensuring oversight, accuracy, and compliance.
Stay updated with coding guidelines to ensure better accuracy and efficient revenue cycle management.
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