diabetestalk.net

Coding Guidelines For Diabetes With Manifestations

Icd-9-cm Vs. Icd-10-cm: Examine The Differences In Diabetes Coding

Icd-9-cm Vs. Icd-10-cm: Examine The Differences In Diabetes Coding

Most coders can quickly come up with 250.00. And if the physician only documented diabetes mellitus, that’s the correct ICD-9-CM code. If a physician doesn’t document complications or type of diabetes, coders default to code 250.00 (diabetes mellitus without mention of complications), says Jill Young, CPC, CEDC, CIMC, president of Young Medical Consulting, LLC, in East Lansing, MI. However, 250.00 is not necessarily the best code to describe the patient’s actual condition. Consider these two patients. Patient A is a type 2 diabetic with well controlled diabetes. Patient B is a type 2 diabetic with uncontrolled diabetes who also suffers from diabetes-related chronic kidney disease. If the physician documents “diabetes mellitus” for both patients, coders would report the same code, even though the patients have very different conditions. The physician loses reimbursement on Patient B, who is sicker and requires more care, Young says. Coding in ICD-9-CM When it comes to the code assignment for diabetes mellitus in ICD-9-CM (250 code series), coders identify whether the diabetes is type 1or 2 using a fifth digit, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM/coding for HCPro, Inc., in Danvers, Mass, and an AHIMA-approved ICD-10-CM/PCS trainer. If the diabetes is secondary, coders choose from codes in the 249 series. Under series 250, coders will find 10 different subcategories that further define and refine the patient’s actual condition. All of those codes require a fifth digit to indicate whether the diabetes is controlled or uncontrolled, type 1or type 2. The fifth digit subclassifications are: Coders also need to note that codes 250.4, 250.5, 250.6, 250.7, and 250.8 all include instructions to use an additional code to ide Continue reading >>

Correctly Coding: Diabetes Mellitus

Correctly Coding: Diabetes Mellitus

When selecting International Classification of Diseases, Tenth Revision (ICD-10), diagnostic codes, accuracy is important when describing the patient’s true health. A joint effort between the healthcare provider and the coder/biller is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. Diabetes mellitus is one of the most inaccurately coded chronic conditions. Many billers/coders/providers are missing opportunities to show which patients are sicker and are at a higher risk. The prevalence of diabetes mellitus and the complexity of diabetes coding require a solid understanding of the ICD-10 coding guidelines to ensure accurate code assignment. These diagnosis codes are also used in determining the eligible population for the Comprehensive Diabetes Care quality measure and the threshold the member is held to in order to be in control for the Controlling High Blood Pressure quality measure. ICD-10 Category E11* Diabetes Mellitus: Tips on How to Code using ICD-10 Codes Diabetes Mellitus is an HCC (Hierarchical Condition Category) The diabetes mellitus codes are combination codes that include: 1. The type of diabetes mellitus 2. The body system(s) affected 3. The complications affecting the body system(s) When coding diabetes mellitus, you should use as many codes from categories E08-E13* as necessary to describe all of the complications and associated conditions of the disease. These categories are listed below: ICD-10 Code Category ICD-10 Description Note: E08* Diabetes mellitus due to underlying condition Code first the underlying condition Use additional code to identify any insulin use E09* Drug or chemical induced diabetes mellitus Code first poisoning due to drug or toxin, if applicable Use addi Continue reading >>

Coding Diabetes: Time To Look At The Coding Guidelines Again

Coding Diabetes: Time To Look At The Coding Guidelines Again

November is National Diabetes Awareness Month, prompting coders to review the coding guidelines for this disease suffered by more than 10.9 million U.S. residents. During November, the Centers for Medicare & Medicaid Services (CMS) is raising awareness about diabetes, diabetic eye disease, the importance of early disease detection, and related preventive health services covered by Medicare. According to the CMS website, diabetes can lead to severe complications such as heart disease, stroke, vision loss, kidney disease, nerve damage, and amputation, among others, and it’s a significant risk factor for developing glaucoma. People with diabetes are more susceptible to many other illnesses such as pneumonia and influenza and are more likely to die from these than people who do not have diabetes. Among U.S. residents 65 years and older, 10.9 million (26.9 percent) had diabetes in 2010. Currently, 3.6 million Americans 40 and older suffer from diabetic eye disease. Education and early detection are major components to combating this disease. Let’s take a look at the coding guidelines for diabetes to ensure that we accurately select and capture the ICD-10-CM code(s) for this disease. As all health information management (HIM) coding professionals know (or should know), the ICD-10-CM Official Coding and Reporting Guidelines have been approved by the four organizations that make up the Cooperating Parties for ICD-10: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS), and National Center for Health Statistics (NCHS). These official coding guidelines are organized into four sections. Section I includes the structure and conventions of the classification and general guidel Continue reading >>

Reporting Diabetic Manifestations

Reporting Diabetic Manifestations

Diabetes mellitus is on the rise and data regarding its type, manifestations and impact on cost and length of stay are needed to assess the effectiveness of current evaluation and management. Diabetes mellitus is on the rise and data regarding its type, manifestations and impact on cost and length of stay are needed to assess the effectiveness of current evaluation and management. Medicare claims data can provide important information about diabetes mellitus if physicians provide complete and accurate documentation, which includes the following elements. Is the patient's diabetes mellitus type 1 or type 2? A patient whose diabetes is controlled by insulin does not necessarily have type 1 disease. To promote accurate reporting and risk adjustment, avoid terminology such as non-insulin dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). We now have an ICD-9-CM code to report long-term use of insulin (V58.67). This code is often added for type 2 diabetics using long-term insulin to support insurance payment for additional testing materials. Secondary diabetes is now distinguishable from type 1 or type 2 diabetes. In 2008, new ICD-9-CM codes were created for diabetes caused by another disease or certain drugs. Physicians must also document the condition causing the secondary diagnosis, for example, Cushing's syndrome, cancer of the pancreas, or long-term use of steroids or other drugs. A cause-and-effect relationship between diabetes and most other conditions may not be assumed. The physician must document the relationship between the condition and diabetes unless the coding guidelines specify otherwise. A manifestation may be presumed when documented as diabetes with, with mention of, associated with or in the respective condition (e.g., di Continue reading >>

Medical Billing And Coding Forum

Medical Billing And Coding Forum

We have a Provider who while examining a patient only discussed or reviewed the Diabetes during an office visit. The patient has Diabetes with a manifestation but he did not address nor reference the manifestation in his notes. He coded the encounter with a 250.40 diabetes II renal manifestations. The coders came back to him asking him to update his note to reference the manifestation as in renal manifestation is being handled by Doctor such and such and to add the renal manifation ICD9 code to the enounter. The Provider is refusing to since he did not mention or deal with the renal manifestation. Question is we cant leave the 250.40 ICD9 code on this encounter as it is incomplete without the mention of the manifestation as well as coding of the manifestation but can we actually change it back to a 250.0X code since the patient is already diagnosed with the manifestation diabetes code in prior encounters?? Not sure what to do in this situation so any help would be greatly appreciated!!! Thanks, Jenn Each encounter has to stand on its own from the documetation so without mention of the complication of the renal issue then you have no choice but to change the code to match. So I would chose the 250.0x. Some of our physician documents condition as diabetes with renal manifestation and does not specify what the manifestation is. Our coders, code this condition with only 250.40, is this correct, please give your suggestion on this. Last edited by Sanjith; 12-28-2010 at 12:28 AM. When coding Diabetes with a manifestation you should add the manisfestation. Here are some examples for renal. 250.40 Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled Use additional code, to identify manifestation, as: Some of our physician documents condit Continue reading >>

Coding Diabetes Mellitus With Associated Conditions

Coding Diabetes Mellitus With Associated Conditions

Overseen by AHIMA’s coding experts for the Journal of AHIMA website, the Code Cracker blog takes a look at challenging areas and documentation opportunities for coding and reimbursement. Check in each month for a new discussion. There has been some confusion among coding professionals regarding interpretation of the coding guideline of “with.” An area that contains many instances of using this guideline in ICD-10-CM is coding Diabetes Mellitus with associated conditions. There are 53 instances of “with” subterm conditions listed under the main term Diabetes. The ICD-10-CM Official Guidelines for Coding and Reporting states the following at Section I.A.15: The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. There was a recent clarification regarding this guideline published in the first quarter 2016 issue of AHA Coding Clinic on page 11. According to this clarification, the subterm “with” in the Index should be interrupted as a link between diabetes and any of those conditions indented under the word “with.” Following this guidance as we look to the main term Diabetes in the ICD-10-CM Codebook Index, any of the conditions under the subterm “with” such as gangrene, neuropathy, or amyotrophy (see below for the full list) can be coded without the physician stating that these conditions are linked. The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system. The following are all the subterms under “with” under th Continue reading >>

Diabetes Mellitus Coding Guidlines

Diabetes Mellitus Coding Guidlines

Diabetes Mellitus Coding Guidelines Sommer Huseman, RN, Risk Adjustment and Coding Specialist Diabetes mellitus is a condition that results when the body is unable to produce enough insulin or properly use the insulin that it does produce. The disease of diabetes is present in a significant number of patients and consumes more than $100 million in health care resources in the United States. Therefore, it is important that the guidelines for coding diabetes mellitus are understood. Correct coding of diabetes is critical in determining the correct reimbursement for encounters related to this disease and for tracking health care services provided for this population of patients. An incorrect code may result in a medical necessity denial for outpatient service. Before assigning a code there are three considerations you must keep in mind. What type of diabetes does the patient have? Does the documentation indicate that the diabetes is controlled or uncontrolled? Are there manifestations or complications and what are they? The ICD-9-CM code for diabetes is assigned to category 250 Diabetes Mellitus. The fourth digit is determined by the presence of manifestations or complications identified due to diabetes. The fifth digit determines the type of diabetes and whether it is uncontrolled or not stated as uncontrolled. Types of Diabetes There are two types of diabetes mellitus: Type I and Type II. We have seen significant confusion on how to choose the correct type of diabetes to code. Terms like IDDM, NIDDM, adult onset and juvenile are often documented in the medical record but the guidelines for coding using these terms are contradictory and have been open for interpretation. Therefore, effective Oct. 1, 2004, the code descriptions for the fifth-digit selection of category 250 Continue reading >>

Coding Tip: Dm With Assumed Conditions

Coding Tip: Dm With Assumed Conditions

Diabetes continues to be a challenge for coders since the new instruction/guideline was released in AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016. This is effective with March 18, 2016 discharges. ICD-10-CM does assume the link between diabetes and multiple common conditions. In the past, these were not assumed and only coded as related to diabetes when clearly documented or queried by the coder for further clarification. In the index of ICD-10-CM you will see several assumed conditions. Please continue to familiarize yourself with these so when you are coding the records you will know they are assumed conditions. Heres a list of the associated diabetic conditions where the link is assumed in ICD-10-CM: If the MD documents another etiology for the condition DO NOT code to a diabetic complication or assume the link with diabetes. Clarification of link of diabetes and osteomyelitis was published in the 4Q2016 AHA Coding Clinic. AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016 AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2016 ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. Continue reading >>

Coding Diabetes Mellitus In Icd-10-cm: Improved Coding For Diabetes Mellitus Complements Present Medical Science

Coding Diabetes Mellitus In Icd-10-cm: Improved Coding For Diabetes Mellitus Complements Present Medical Science

Results of a recent coding and clinical documentation pilot study indicate that the ICD-10-CM coding classification changes made for diabetes mellitus have significantly improved coding for this disease. The results of the study noted that although a few ICD-10-CM "unspecified" diabetes codes were assigned, the majority of the diabetes codes sufficiently captured the diagnoses as expressed in the clinical documentation. In addition, the pilot study noted that the ICD-10-CM diabetes codes complement present medical science-separate type 1 and type 2 diabetes category codes and body system combination codes are a major improvement over ICD-9-CM. Instead of classifying as controlled or uncontrolled, ICD-10-CM classifies inadequately controlled, out of control, and poorly controlled diabetes mellitus by type with hyperglycemia. This article highlights key ICD-10-CM features for diabetes mellitus coding. In ICD-10-CM, chapter 4, "Endocrine, nutritional and metabolic diseases (E00-E89)," includes a separate subchapter (block), Diabetes mellitus E08-E13, with the categories: E08, Diabetes mellitus due to underlying condition E09, Drug or chemical induced diabetes mellitus E10, Type 1 diabetes mellitus E11, Type 2 diabetes mellitus E13, Other specified diabetes mellitus The diabetes mellitus categories E08–E13 are further subdivided into four- or five-character subcategories. When a category has been subdivided into four-, five-, or six-character codes, the diabetes code assigned represents the highest level of specificity within ICD-10-CM. ICD-10-CM Tabular Instructional Notes Diabetes mellitus tabular inclusions notes are introduced by the term "Includes" and appear at the beginning of a category. Categories E10–E13 inclusion notes further define or provide examples of th Continue reading >>

Coding Tip Of The Month - February 2017 | Uasi

Coding Tip Of The Month - February 2017 | Uasi

Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Notice: Undefined property: stdClass::$uid in ctools_context_create_user() (line 61 of /var/www/uasisolutions.com/sites/all/modules/ctools/plugins/contexts/user.inc). Many of us have been perplexed and confused by recent Coding Clinic advice in regard to Hypertension and CKD. While we may not always agree with published advice the official coding guidelines and coding clinic guidance are the rules that we must follow when reporting ICD-10-CM/PCS codes. This t Continue reading >>

Coding For Diabetes Mellitus

Coding For Diabetes Mellitus

For The Record Vol. 23 No. 19 P. 27 In type 1 diabetes mellitus (DM), beta cells are destroyed by an autoimmune process that usually leads to a complete loss of insulin production. The majority of patients who develop type 1 DM will do so prior to age 25, with an increased prevalence due to heredity or in patients with other autoimmune diseases. Type 1 DM patients are dependent on insulin. In type 2 DM, the pancreas continues to produce insulin but doesn’t produce enough and doesn’t utilize it properly (insulin resistance). Secondary diabetes is diabetes or glucose intolerance that develops from disorders or conditions other than type 1 or type 2 diabetes or gestational diabetes. Secondary diabetes may bring out primary diabetes in people who are predisposed to developing primary diabetes. Common causes of secondary diabetes include but are not limited to pancreatitis, pancreatectomy; malnutrition, endocrinopathies, and drugs, chemical agents, and toxins. DM is assigned to ICD-9-CM category 250. Secondary diabetes is classified to category 249. When the physician documents DM, additional documentation is necessary to completely classify the condition: type 1 vs. type 2, uncontrolled vs. controlled, and manifestations associated with the condition, if any. The fourth-digit subcategory identifies any condition or manifestation associated with diabetes. The fifth-digit subclassification refers to type 1 or type 2 DM and whether it is controlled or uncontrolled. DM defaults to type 2 if not specifically documented, as this is the most common type. The fact that the patient receives insulin during the hospital stay has no effect on diabetes classification (AHA Coding Clinic for ICD-9-CM, 2005, first quarter, page 44). Uncontrolled diabetes is a nonspecific term indicatin Continue reading >>

Frequently Asked Questions

Frequently Asked Questions

If you have coding questions regarding Medicare Risk Adjustment, HCC codes or general coding and documentation questions please ask a coder at [email protected] . They will be answered in the order received and then posted in the FAQ. Q. If a patient has multiple complications due to diabetes; do I have to code all of the E11.XX codes for each complication? Example, patient has Peripheral Neuropathy and CKD both due to diabetes, can I just code E11.22 for diabetes with renal manifestations. A. No, you must code all of the appropriate E11.XXcodes. If a patient has Peripheral Neuropathy due to diabetes the codes would be E11.40 Diabetes with Neurological Manifestations. For the CKD due to Diabetes you would code E11.22 Diabetes with Chronic Kidney Disease and N18.9 for the unspecified CKD. The diagnosis of Peripheral Neuropathy due to Diabetes and CKD due to Diabetes would require 3 ICD- 10 codes. Q. How do I code Diabetes with other complications? A. When coding Diabetes with other manifestations, coding guidelines require two ICD-10 codes to indicate the entire diagnosis. You would need E11.69 Diabetes with other specified complication and a code to specify what the other complication is. In your documentation, it is advised that you clearly state the relationship of the complication with words such as diabetic, due to diabetes, and/or secondary to diabetes. Each time this code is chosen as the diagnosis a second ("buddy") ICD-10 code MUST be assigned as well. The following are some examples of the "buddy" code. This is not an all-inclusive list Q. I am a podiatrist and if I document Neuropathy and Diabetes, would that be coded E11.42? A. No, you cannot assign E11.42 because your documentation states Neuropathy. You would however be able to assign E11.40 Diabetes Continue reading >>

Icd-10 Training: Coding For Diabetes

Icd-10 Training: Coding For Diabetes

In order to understand diabetes coding in ICD-10, it’s worth making a comparison of the structural differences between ICD-9-CM and ICD-10-CM. Diabetes mellitus (DM) codes in ICD-10-CM are combination codes that include the type of DM, the body system affected, and the complication affecting that body system as part of the code description. Subcategory levels first specify the type of complication by system, such as diabetes with kidney complications, ophthalmic complications, neurological complications, and circulatory complications. The subclassification level then describes the particular manifestation. For example: E11.3: Type 2 diabetes mellitus with ophthalmic complications. E11.32: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy. E11.321: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema. E11.329: Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema. A subcategory for diabetes mellitus with other specified complications is also provided that includes codes for DM with diabetic neuropathic arthropathy, diabetic dermatitis, foot ulcer, other skin ulcer, periodontal disease, hypoglycemia, and hyperglycemia. As many codes as are needed to describe all of the associated complications that the patient has should be assigned from a particular category. Because of this code structure, there is no instructional note found under diabetes mellitus codes in ICD-10-CM requiring an additional code to identify the manifestation since it is already part of the code description. There are specific diabetes codes that do require additional codes in order to identify the manifestation further, such as diabetes with foot ulcer to identify the site of the ulcer, or diabetes Continue reading >>

Tips For Coding Diabetes With Icd-10

Tips For Coding Diabetes With Icd-10

ICD-10 is upon us, and many offices are feeling anxious. Your anxiety is not unfounded. Transitioning from the 13,000 code ICD-9 system to the 68,000 code ICD-10 system is pretty intimidating. Diabetes codes have undergone some of the most significant changes, according to the American Academy of Ophthalmic Executives (AAOE). With 29 million Americans now suffering from the disease, it’s critical for physicians across specialties to correctly code the disorder. The AAO recently addressed the changes to diabetes coding. Consider some of their insight and tips for coding diabetes with ICD-10. Get Specific ICD-10 is very specific, going beyond the general diabetic terms used in ICD-9, such as “controlled” or “uncontrolled, or “adult-onset” or “juvenile-onset.” Now, the codes are based on a system that first identifies the type of diabetes mellitus (DM), the system in the body that is affected and the complication affecting that body system. Physicians will need to be aware of their verbiage when charting or dictating patient conditions. First, start by identifying type 1 or type 2 DM. The two are usually distinguished by the use of insulin. However, clarification may be required from an endocrinologist since insulin is sometimes used by type 2 DM patients. Insulin is coded separately from DM, using code Z79.4. Multiple Codes Have Become One Once type 1 or type 2 diabetes has been identified, added subcategories will help identify how the diabetes is manifesting itself in the body. Let’s break it down a little more. For ophthalmologists that previously recorded a patient’s diabetic condition using three codes, you will now use one combined code. You’ll focus on three factors: Type of diabetes The existence, type and severity of retinopathy The existenc Continue reading >>

What's Up

What's Up "with" Diabetic Coding?

/ 2 Comments /in Coding , Uncategorized /by Giovanna Govea Responding to coder questions has always been one of my great joys. The challenge of searching for the underlying cause or the analysis of a detailed operative note is second only to a Dr. Seuss favorite with my Grands. Lately, diabetic coding has been a frequent topic for clarification. According to the American Diabetes Association,29.1 million Americans have been diagnosed with diabetes with another 86 million identified with pre-diabetes. The manifestations and associated conditions are staggering, as this disease impacts many body systems. In ICD-9-CM code assignment with the designation of primary or secondary whether type I or II, controlled, uncontrolled and with a documented association of manifestations common to diabetes was the guidance. ICD-10-CM implementation eliminated the controlled and uncontrolled designation, opting for a more robust manifestation instruction. The American Hospital Association (AHA) Coding Clinic publications for first quarter 2016, again second quarter 2016 reiterate the ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 I.A.15 which says: With the word with should be interpreted to mean associated with or due to when it appears in the code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must like the condit Continue reading >>

More in diabetes