Ozempic ICD-10 Code Guide: Billing, Side Effects & Injection Coding

Ozempic is highly prescribed for Type 2 diabetes and weight loss, but accurate ICD-10 coding is crucial due to increasing payer scrutiny. Incorrect coding leads to claim denials, reduced reimbursement, and delayed patient care. This guide breaks down diagnosis codes, ensuring clean claims and compliant billing for GLP-1 therapy.

The guide includes ICD-10 codes for primary diagnoses supporting medical necessity, long-term use of the drug, and codes for side effects or adverse reactions. Specific codes for overdose or underdose scenarios are also covered to handle various patient management situations effectively.

To prevent denials and speed up payment, healthcare professionals must ensure accurate diagnosis coding and thorough documentation that clearly aligns with the medical necessity for Ozempic treatment. This step-by-step reference is designed to minimize administrative burden and optimize the billing process.

What Is the Correct ICD-10 Code for Ozempic?

Ozempic does not have its own standalone ICD-10 code because it is a medication, not a diagnosis. Instead, reimbursement for Ozempic is supported by the ICD-10 code of the condition being treated.

Primary ICD-10 Codes Used to Support Ozempic Prescriptions

1. E11.9 – Type 2 diabetes mellitus without complications

• Use when: The patient has Type 2 diabetes without complications, and Ozempic is prescribed for glycemic control.

• Common Use: This is the most widely used ICD-10 code for uncomplicated Type 2 diabetes.

2. E11.65 – Type 2 diabetes mellitus with hyperglycemia

• Use when: The patient has high blood sugar or poor glycemic control, and the provider documents “hyperglycemia” or “poor control.”

• Importance: This code provides stronger payer justification as it shows poor glycemic control.

3. E11.69 – Type 2 diabetes with other specified complications

• Use when: Diabetes leads to additional complications such as endocrine or metabolic issues requiring Ozempic therapy.

• Examples: Endocrine complications, metabolic disorders, or other non-specific issues related to diabetes.

ICD-10 Codes for Long-Term Use of Ozempic

For patients on long-term Ozempic therapy, accurate documentation is essential for medication refills, follow-up visits, and ongoing therapy justification.

Below are the ICD-10 codes related to current, ongoing, or long-term use of Ozempic.

1. Z79.899 – Other long-term drug therapy

• Ozempic is prescribed as a long-term or maintenance treatment, and the visit is for medication monitoring or management.

• Z79.899 must always be paired with the primary diagnosis code (e.g., E11.9 or E11.65).

2. Z79.85 – Long-term use of injectable non-insulin antidiabetic drugs

• The patient is on Ozempic or another GLP-1 medication (e.g., Trulicity, Mounjaro) for long-term use.

• This code is specific to GLP-1 medications and may reduce medical necessity denials from payers.

ICD-10 Codes for Ozempic Injection & Administration

Ozempic is mostly self-administered, but certain visits require documentation. Use these codes when the encounter involves medication monitoring or education:

• Z51.81 – Drug therapy monitoring
  Used for follow-ups, dose adjustments, and monitoring treatment response.

• Z79.85 or Z79.899 – Long-term medication use
  Apply when the patient is on ongoing Ozempic therapy.

• Z71.89 – Counseling
  Use for coaching on injection technique, diabetes education, or lifestyle guidance.

These codes simply support follow-up visits associated with Ozempic treatment.

ICD-10 Codes for Ozempic Side Effects & Adverse Reactions

If a patient experiences side effects or adverse reactions to Ozempic, it’s important to document these accurately using the appropriate ICD-10 codes.

1. T38.3X5A – Adverse effect of GLP-1 drugs (initial encounter)
2. T38.3X5D – Adverse effect of GLP-1 drugs (follow-up encounter)

• Use when: The patient experiences adverse effects related to GLP-1 drugs like Ozempic. Documentation of symptoms, severity, and duration is required.

3. Z88.8 – Documented allergy to Ozempic

• Use when: The patient has an allergy to Ozempic. If necessary, include additional symptom codes such as R11.2 (nausea) or R10.9 (abdominal pain) for further clarity.

ICD-10 Codes for Overdose or Underdose

In the case of accidental overdose or underdose of Ozempic, these codes should be used:

1. T38.3X1A – Accidental overdose of Ozempic
2. T38.3X6A – Underdosing of Ozempic
3. T38.3X4A – Poisoning, cause undetermined

• Use with: Relevant symptom codes, such as R73.9 (abnormal glucose), if necessary.

Documentation Requirements for Ozempic Billing

 

Documentation Requirement	What Must Be Documented	ICD-10 Codes Supported	Why It Matters
Primary Diagnosis Supporting Ozempic Use	- Confirm the Type 2 diabetes diagnosis, including A1C levels, disease duration, and previous treatments.	E11.9, E11.65, E11.69, etc.	Establishes medical necessity, prevents denials
Long-Term or Current Use of Ozempic	- Duration of therapy- Dose and titration notes- Response to treatment- Medication adherence	Z79.85, Z79.899	Required for refills, monitoring visits, long-term therapy claims
Medication Adjustments / Changes	- Dose increase/decrease- Switching medications- Tolerance and side effects- Clinical reasoning for change	Z51.81, Z79.85, Z79.899	Supports follow-up and medication management billing
Side Effects or Adverse Reactions	- If there are dose changes or medication switches, document the reason for the change	T38.3X5A, T38.3X5D, R11.2, K85.90,	Required for adverse reaction claims; prevents medical necessity rejections
Overdose, Underdose, or Incorrect Use	- Provide a clear description of the event, symptoms, and corrective actions taken.	T38.3X1A, T38.3X6A, T38.3X4A,	Ensures proper coding for overdose/underdose encounters
Lifestyle or Medication Counseling	- Diet counseling- Exercise guidance- Medication adherence education- Behavior change notes	Z71.89	Supports CCM/PCM billing and payer-required counseling documentation
Payer-Specific Requirements	- Failed previous medications- Uncontrolled A1C before starting- BMI (if used for weight loss)- Diabetes complications	Depends on the payer and diagnosis	Prevents denials for medical necessity or policy mismatch
Mandatory Clinical Details in Every Record	- Medication name: Ozempic (Semaglutide)- Dosage & frequency- Route of administration- Expected outcomes- Monitoring schedule	Supports ALL ICD-10 combinations	Ensures claims withstand audits, supports appeals

 

Common Claim Denials for Ozempic & How to Fix Them

Incorrect or Missing ICD-10 Codes: Ensure that the diagnosis codes (e.g., E11.9, E11.65) are paired correctly with long-term use codes (Z79.85, Z79.899).

Lack of Medical Necessity: Document A1C levels, prior medication failures, and the clinical rationale for prescribing Ozempic.

Ozempic Prescribed for Weight Loss (Off-Label): Confirm payer coverage for weight loss before prescribing Ozempic for obesity alone.

Missing Documentation for Long-Term Use: Update documentation for long-term therapy, and ensure that Z-codes are used to support continuous treatment.

Failure to Document Side Effects: Include detailed side effect symptoms and relevant ICD-10 codes (e.g., T38.3X5A, T38.3X5D) for adverse reactions.

Overdose/Underdose Not Properly Documented: Clearly document the cause of the overdose or underdose, encounter type, and symptoms. Pair with the appropriate codes (T38.3X1A, T38.3X6A) and any relevant symptom codes.

Conclusion

Applying these coding practices keeps claims clean, reduces rejections, and supports a healthier revenue cycle. Clear documentation and accurate coding allow providers to focus more on patient care and less on administrative complications.

If your practice needs support with Ozempic billing, prior authorization, or ICD-10 accuracy, HMS USA LLC is ready to help. Our billing experts ensure compliant claims, proper coding, and faster reimbursements.

📞 Contact HMS USA LLC for professional medical billing support today.