November 5, 2025
Type 2 Diabetes in Remission — Understanding the New E11.A Code for FY 2026
The FY 2026 ICD-10-CM update, effective October 1, 2025, introduced a new diagnosis code — E11.A (Type 2 diabetes mellitus in remission).
This addition reflects growing recognition that some patients can achieve long-term remission of Type 2 diabetes, often after significant lifestyle changes or metabolic interventions such as bariatric surgery. For inpatient coders, this change allows for more precise data capture and accurate representation of a patient’s current clinical status.
What’s New
Prior to FY 2026, coders had limited options when providers documented phrases such as “Type 2 diabetes resolved” or “in remission.” These cases often led to inconsistent coding, since the only available choices were:
- E11.xx — Active diabetes, or
- No diabetes code at all
The addition of E11.A closes that gap. It recognizes patients who no longer meet the clinical criteria for active diabetes but remain at increased risk for recurrence. Type 2 DM in remission has been defined as achieving an HbA1C level of less than 6.5% for at least three months after cessation of all glucose lowering medication.
Documentation Requirements
To code E11.A, provider documentation must clearly state that the patient’s diabetes is “in remission.”
The term “controlled” or “well-controlled” is not enough — these still represent active disease.
Terms such as “history of T2DM” and “resolved T2DM” might be documented, but are not synonymous with T2DM in remission. When it is unclear, a provider should be queried
Here’s what coders should confirm in the health record:
- Provider statement: The provider must explicitly state “Type 2 diabetes mellitus in remission.”
- Treatment status: The patient should not be taking insulin or oral hypoglycemics.
- Lab results: Normal glucose or HbA1c levels may support the remission status, but cannot be coded on their own without provider confirmation.
- Duration of remission: While not required for coding, duration (e.g., “in remission for 2 years”) strengthens the clinical picture.
Coding Example
Documentation: “Patient with prior history of Type 2 diabetes, now maintains normal blood glucose and A1c after bariatric surgery. No current medications. Type 2 diabetes in remission.”
Code Assignment:
- E11.A — Type 2 diabetes mellitus in remission
If the provider instead documents “controlled” or “diet-controlled diabetes,” continue to assign E11.9 — Type 2 diabetes mellitus without complications.
Common Pitfalls
- Coding based on labs alone: Do not assign E11.A without a provider statement.
- Using ‘history of diabetes’ only: A “history of” note without mention of remission does not qualify for E11.A.
- Applying to Type 1 diabetes: The remission concept applies only to Type 2 diabetes at this time.
- Omitting secondary risk codes: Consider Z86.39 (Personal history of other endocrine disorders) if the provider documents long-term follow-up without current disease.
Why This Matters
- Accurate use of E11.A improves: Clinical communication: Providers and coders share a clear understanding of disease status.
- Population health data: Public health agencies can track remission rates more accurately.
- Risk adjustment and quality metrics: Prevents overcoding active disease, which can affect reporting, reimbursement, and care management metrics.
- This small but meaningful change encourages better alignment between coding and real-world outcomes — reflecting advances in diabetes treatment and remission recognition.
References
- FY 2026 ICD-10-CM Official Guidelines for Coding and Reporting (Effective 10/1/2025) Section 1.C.4.A.1.b
- ICD-10-CM/PCS Coding Clinic, Fourth Qtr ICD-10 2025, Pages 6-7
Jessica Lutz, MBA, RHIA, CCS
AHIMA Micro-credential: Auditing: Inpatient Coding
Senior Consultant, Audit at UASI
Jessica Lutz serves as a Senior Consultant in Auditing at UASI and is recognized for her ICD-10-CM/PCS expertise and inpatient coding background. She shares coding tips from an auditor’s perspective, highlighting common pitfalls and practical ways coders and CDI teams can improve accuracy and documentation quality.
