2025 ICD-10-CM code Z79.85
(Active) Effective Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status 21. Factors influencing health status and contact with health services (Z00-Z99) Feed
Long-term (current) use of injectable non-insulin antidiabetic drugs.
The medical necessity for this code relies on the documented diagnosis of diabetes and the established treatment plan indicating the ongoing need for injectable non-insulin antidiabetic medication. The documentation should support the clinical rationale for the choice of this specific class of medication within the overall diabetes management strategy.
Clinicians managing patients with diabetes are responsible for accurately documenting the medication regimen, including the specific type of antidiabetic medication (injectable non-insulin), to support the use of this code.
In simple words: This code indicates that the patient is currently taking non-insulin diabetes medications that are administered by injection,but not insulin itself or diabetes pills.
This code signifies the ongoing use of injectable non-insulin antidiabetic medications for the management of diabetes.It excludes the use of insulin (Z79.4) and oral hypoglycemic drugs (Z79.84).
Example 1: A patient with type 2 diabetes receives a regular injection of a GLP-1 receptor agonist like liraglutide (brand name Victoza) to manage their blood sugar levels.They visit their physician for a routine check-up. The appropriate code is Z79.85., A patient with type 2 diabetes is prescribed a weekly injection of dulaglutide (brand name Trulicity). They present to an urgent care clinic with a minor unrelated illness (e.g., common cold). The diabetes medication should still be documented with Z79.85 in addition to the code for the acute illness., A patient with type 2 diabetes manages their condition with both oral metformin and injectable semaglutide (brand name Ozempic). They come to the clinic for diabetes education. Both Z79.84 (for the metformin) and Z79.85 (for the Ozempic) should be coded, along with the appropriate code for the diabetes education encounter.
Documentation must clearly indicate the long-term use of an injectable, non-insulin antidiabetic medication.The specific medication name should be documented.The documentation should also confirm the current and ongoing nature of the therapy. Any concurrent use of other diabetic medications (like insulin or oral hypoglycemics) or devices (like insulin pumps) must also be clearly documented.
- Specialties:Endocrinology, Internal Medicine, Family Medicine, Primary Care
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Nursing Facility, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home