Medical Billing And Coding Forum
How to Code long standing diabetes and hypertension patient presents to office for evaluation of long standing diabetes and hypertension. coder coded I10 and E11.8 (auditor asked to recheck E11.8) any help? What do you think about the Type 2 diabetes mellitus with unspecified complication? You may want to review ICD-10-CM guideline I.A.15 to see if it might apply here. CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010) Fee Schedule Configuration Specialist - Remote 15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement I check the coding guidelines and it referenced coding the E11 however I coded E11.8 which does state type 2 diabetes mellitus with unspecified complications but the auditor is stating that's wrong. I will submit my rational and reference the coding guidelines. Long standing diabetes is not in and of itself a complication. unless there is a complication documented or hypertension listed under the word "with" in the alpha listing then there is no reason for coding diabetes with an unspecified complication. I am curious as to why you feel this is an appropriate selection. why not E11.9 since you didn't mention any complications? I did recode the dx to E11.9 and it was right. you are the best!!!! Thanks for your help. I am going to be sending two more your way in just a second if you can help me out that would be great! Patient presents for anemia. Dietician documents BMI of 35.6. Patient is treated with iron for the anemia. I coded it D64.9 and Z68.35 but I was cited by the auditor. The first time I was cited for coding it with just the D50.9. However, I did look at D50.9 and Z68.35 any thoughts? This other one is really confusing me because I was cited twice Patient is 62 y Continue reading >>
Icd-10 | Coding | Acp
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas: ACP offers a number of resources to help members make sense of the MOC requirements and earn points. The most comprehensive meeting in Internal Medicine. Claim CME/MOC for attending Internal Medicine Meeting 2018 and register for Internal Medicine Meeting 2019 in Philadelphia, PA, April 11-13, 2019. Upcoming Internal Medicine Board Review Courses Prepare for the Certification and Maintenance of Certification (MOC)Exam with an ACP review course. Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration. ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas: Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572 Toll Free: (800) 523.1546 Local: (215) 351.2400 Home Practice Resources Business Resources Coding ICD-10 While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors did not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Beginning on October 1, 2016, the one-year contingency period d Continue reading >>
Hypertension In Icd 10
No Hypertension table in ICD-10-CM There are no separate codes for benign or malignant hypertension No longer a need for the hypertension, unspecified code Listing in the Tabular List of Diseases and Injuries Diseases of the circulatory system (I00 – I99) I10-I15 Hypertensive diseases I10 - Essential (primary) hypertension I11 - Hypertensive heart disease I11.0 - Hypertensive heart disease with heart failure I11.9 - Hypertensive heart disease without heart failure I12 - Hypertensive chronic kidney disease I12.0 - Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease I12.9 - Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13 - Hypertensive heart and chronic kidney disease I13.0 - Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13.1 - Hypertensive heart and chronic kidney disease without heart failure I13.10 - Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease I13.11 - Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease I13.2 - Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease I15 - Secondary hypertension I15.0 - Renovascular hypertension I15.1 - Hypertension secondary to other renal disorders I15.2 - Hypertension secondary to endocrine disorders I15.8 - Other secondary hypertension I15.9 - Secondary hypertension, unspecified Look for these Guidelines Hypertension with Hear Continue reading >>
Icd-10: Key Changes For Primary Care
Transitioning successfully to the new ICD-10-CM code setwill be particularly important for primary care physicians.ICD-10-CM will allow primary care specialists to moreaccurately depict chronic conditions as well as othercommonly reported diagnoses. Physicians will need to be more specific in theirdocumentation than they likely have been in the past.Because there will be a greater number of code choicesin ICD-10-CM, physicians should have to choose anunspecified code less often. The greater specificityin diagnostic coding should help improve diseasemanagement and reporting overall. Dental and Vision Coverage for You and Your Staff CAP is pleased to offer high-quality dental and vision coverage available for purchase at significant discounts over the retail market. Practices should examine their top diagnoses and comparehow those codes will change once ICD-10-CM goes intoeffect October 1, 2015. Here are some diagnoses to whichprimary care providers should pay close attention. This iscertainly not an all-encompassing list, but is an example ofsome of the common diagnoses often reported by the PCP. Diabetes (codes E08 E13) has greatly expanded in ICD-10-CM. Physicians must document whether the diabetesis Type 1, Type 2, drug- or chemical-induced, or due to anunderlying condition. They must document the specificunderlying condition, the specific drug or toxin, as well asthe use of any insulin. ICD-10-CM requires very specific details regarding anycomplications or manifestation of the diabetes. For example,code E08.341 denotes diabetes mellitus due to underlyingcondition with severe non-proliferative diabetic retinopathywith macular edema. ICD-10-CM code I10 denotes essential (primary)hypertension. There are separate codes for hypertensioninvolving vessels of the brain (cod Continue reading >>
Coding Clinic Solves Documentation Issues, Changes Paradigm For Diabetes And Heart Failure Coding
Coding Clinic Solves Documentation Issues, Changes Paradigm for Diabetes and Heart Failure Coding By Allen R. Frady, RN, BSN, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer As many of you may know by now, the often-discussed question of what to do about physicians use of new clinical practice terms that do not correspond to ICD-10 codes was recently addressed in the Coding Clinic for the first quarter of 2016. Heart failure with reduced ejection fraction or preserved ejection fraction now can be coded without further specification by the physician. Additionally, terms such as heart failure with preserved systolic function or reduced systolic function and other such terms now can be assigned without further clarification from the attending physician. Whats more, the abbreviations HFpEF and HFrEF also officially now are being accepted as documentation specifying type of heart failure. The terms acute or chronic still will need to be present in the chart somewhere, of course. This is a full reversal of previous Coding Clinic advice indicating just the opposite. For those of you who may not know how those terms translate, the following terms should be helpful: a) reduced ejection fraction = systolic heart failure; b) preserved ejection fraction = diastolic heart failure; c) preserved systolic function = diastolic heart failure; d) reduced systolic function = systolic heart failure; e) HFrEF = systolic heart failure; and f) HFpEF = diastolic heart failure. There isnt a version that translates into combined systolic and diastolic heart failure. This change of heart apparently came after review of additional information from the American Cardiology Association. Perhaps even more interesting, however, is something that appears in another section of the same issue of Coding Cl Continue reading >>
Type 2 Diabetes Mellitus With Diabetic Chronic Kidney Disease
Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus with hyperparathyroidism due to end stage renal disease on dialysis Chronic kidney disease stage 1 associated with type 2 diabetes mellitus Chronic kidney disease stage 1 due to type 2 diabetes mellitus Chronic kidney disease stage 2 associated with type 2 diabetes mellitus Chronic kidney disease stage 2 due to type 2 diabetes mellitus Chronic kidney disease stage 3 associated with type 2 diabetes mellitus Chronic kidney disease stage 3 due to type 2 diabetes mellitus Chronic kidney disease stage 4 associated with type 2 diabetes mellitus Chronic kidney disease stage 4 due to type 2 diabetes mellitus Chronic kidney disease stage 5 associated with type 2 diabetes mellitus Chronic kidney disease stage 5 due to type 2 diabetes mellitus Chronic kidney disease with end stage renal disease on dialysis due to type 2 diabetes mellitus Chronic renal impairment associated with type 2 diabetes mellitus Diabetes 2 with end stage renal disease on dialysis Diabetes type 2 on dialysis Diabetes type 2 with chronic kidney disease Diabetes type 2 with kidney disease Diabetes type 2 with mild chronic kidney disease Diabetes type 2 with mild kidney disease Diabetes type 2 with moderate kidney disease Diabetes type 2 with severe kidney disease Diabetes type 2, mild chronic kidney disease Diabetes type 2, moderate chronic kidney disease Diabetes type 2, severe chronic kidney disease Dm 2 w diabetic ckd, secondary hyperparathyroidism due to esrd, on dialysis End stage renal disease on dialysis due to type 2 diabetes mellitus Hypertension concurrent and due to end stage renal disease on dialysis due to type 2 diabetes mellitus Hypertension in chronic kidney disease due to type 2 diabet Continue reading >>
Top Outpatient Diagnosis Codes With Icd-10 Documentation Tips
Page 1 of 8 This ICD-10 Tipsheet is meant to assist providers for the transition from ICD-9-CM to ICD-10-CM. Content provided is informal guidance, and any definitive guidance is issued from CMS. The following are important documentation tips and strategies for ICD-10 compliance: ICD-9 Code and Name ICD-10 Code(s) from GEMS ICD-10 Documentation Tips 789.00 - Abdominal pain, unspecified site R10.9 - Unspecified abdominal pain ï‚ŸState symptoms such as abdominal pain, tenderness, rigidity, swelling, masses, and lumps. ï‚ŸIdentify the region or quadrant of the abdomen where the symptom resides (e.g., right upper quadrant, left lower quadrant, left lower quadrant, epigastric, periumbilical, generalized, etc.). ï‚ŸSpecify the phase of swallowing affected by dysphasia (e.g., oral, oropharyngeal, pharyngeal, pharyngoesophageal, etc.). ï‚ŸDetail other dysphagias (e.g., neurogenic). ï‚ŸProvide the underlying cause of ascites (e.g., malignancy, alcoholic cirrhosis, alcoholic hepatitis, chronic active hepatitis in toxic liver disease, etc.). 466.0 - Acute bronchitis J20.9 - Acute bronchitis, unspecified ï‚ŸSpecify the acuity of the disease (i.e., acute, subacute, or chronic). ï‚ŸInclude the causative organism (e.g., Mycoplasma pneumoniae, streptococcus, rhinovirus, etc) and any other disease process associated with the bronchitis (e.g., chronic obstructive asthma, bronchitis due to allergies, bronchitis due to fumes). ï‚ŸDelineate when both acute and chronic bronchitis are present. ï‚ŸList any related tobacco use, abuse, dependence, or exposure (e.g., second hand, occupational, etc.). 462 - Acute pharyngitis J02.9 - Acute pharyngitis, unspecified ï‚ŸIdentify and link any associated manifestations such as: laryngitis, pleural effusion, pneumo Continue reading >>
Validity Of Canadian Discharge Abstract Data For Hypertension And Diabetes From 2002 To 2013
Validity of Canadian discharge abstract data for hypertension and diabetes from 2002 to 2013 We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Validity of Canadian discharge abstract data for hypertension and diabetes from 2002 to 2013 Jason Jiang, MSc, Danielle Southern, MSc, [...], and Hude Quan, MD, PhD Surveillance using coded administrative health data has shown that the prevalence of hypertension and diabetes in Canada increased substantially between 1998 to 2008. These findings require an assumption that the validity of hypertension and diabetes coding is stable over time. We tested this assumption by examining temporal trends in the validity of coding for hypertension and diabetes in the Canadian hospital Discharge Abstract Database. We used the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database, a clinical registry, as the reference standard to evaluate the validity of the Discharge Abstract Database in recording hypertension and diabetes in Alberta. The APPROACH database contains data for all Alberta residents who have undergone cardiac catheterization and includes prospective ascertainment of comorbid conditions before each procedure. We linked patient data between the 2 databases for 2002 to 2013 using patient provincial health number. Temporal trends in sensitivity, specificity, positive predictive value, negative predictive value and Cohen were calculated for both hyperten Continue reading >>
- Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study
- Diabetes and Hypertension: A Position Statement by the American Diabetes Association
- Increased heart rate and cardiovascular risk in hypertension and diabetes
Icd-10, Part 4: How To Code For Diabetic Retinopathy
Written By: Elizabeth Cottle, CPC, OCS, Rajiv R. Rathod, MD, MBA, Sue Vicchrilli, COT, OCS, and E. Joy Woodke, COE, OCS Finding the ICD-10 codes for diabetic retinopathy can be tricky. They are not listed in Chapter 7, Diseases of the Eye and Adnexa (H00-H59), but are in the diabetes section (E08-E13) of Chapter 4, Endocrine, Nutritional and Metabolic Diseases. Retinal complications. To further confuse matters, the most common retinal complications are in Chapter 7, not Chapter 4. Examples include vitreous hemorrhage (H43.1-), traction detachment of retina (H33.4-), and rubeosis iridis (H21.1-). New options. ICD-10 features codes for diagnoses that don’t currently have codes. These include drug- or chemical-induced diabetes mellitus (E09.-); gestational diabetes (Q24.4-); neonatal diabetes mellitus (P70.2); and postpancreatectomy, postprocedural, or secondary diabetes mellitus (E13.-). Changes in Documentation Some terms that you’re using in charts—such as “NIDDM,” “controlled,” and “uncontrolled”—will be obsolete when ICD-10 starts on Oct. 1, 2015. Instead, diabetes documentation should address the following questions: Is it type 1 or type 2? Is there diabetic retinopathy? If so, is it proliferative or nonproliferative? If nonproliferative, is it mild, moderate, or severe? Is there macular edema? Preparedness tips. To help you work through that series of questions, the AAOE has developed a decision tree that you can laminate and keep for reference at the coder’s desk. Download it at www.aao.org/icd10. You also should update your intake form so that staff can capture the type of diabetes. Insulin use? Submit Z79.4 as supporting documentation indicating any insulin use. What’s the Underlying Condition? According to ICD-10 instructions, physicians Continue reading >>
Coding Hypertension And Hyperlipidemia
HYPERTENSION in ICD-9 Blood pressure can vary a day or a week. Therefore, one occurrence of an elevated blood pressure reading is not usually diagnosed as hypertension. ICD-9-CM code 796.2 is assigned for elevated blood pressure without a diagnosis of HTN and also for transient or borderline hypertension. Look at the hypertension table in the index. Once the diagnosis of HTN is established by a provider, a code from category 401 is assigned, with a fourth digit required: 0 for malignant, 1 for benign, and 9 for unspecified. ** Do not assign a code for benign or malignant HTN unless it is specifically documented by a physician. Continue reading >>
What Are The Icd-10 2018 Coding Guidelines For Chronic Kidney Disease?
What are the ICD-10 2018 Coding Guidelines for Chronic Kidney Disease? More than 660,000 Americans have kidney failure, according to the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK). People with CKD face a very high risk of cardiovascular disease, with renal impairment progressing to loss in renal function over time. Once the physician makes a diagnosis of CKD, it should be coded appropriately to reflect the correct stage of the kidney disease. Physicians can ensure proper ICD-10 code assignment by partnering with a medical coding service provider that understands CKD, its causes and risk factors, and treatment options. Diabetesandhigh blood pressure are the two main causes of CKD. Diabetes causes damage to many organs, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, if poorly controlled, is a leading cause of heart attacks, strokes and CKD. Also, CKD can cause high blood pressure. Other conditions that affect the kidneys are: Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidneys filtering units. Polycystic kidney disease, an inherited disease which causes large cysts to form in the kidneys and damage the surrounding tissue. Malformationsthat occur as a baby develops in its mothers womb and affect the kidneys. Lupusand other diseases that damage the bodys immune system. Kidney stones, tumors or an enlarged prostate gland in men. The rising incidence of CKD is attributable to factors such as aging population and the higher prevalence of co-morbidities, such as, hypertension, diabetes, and obesity. Patients with CKD may also experience acute kidney failure (AKF), which is abrupt loss of the ability of the kidneys to remove waste and concentrate ur Continue reading >>
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 >>
2012 Icd-9-cm Diagnosis Code 250.40 : Diabetes With Renal Manifestations, Type Ii Or Unspecified Type, Not Stated As Uncontrolled
Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled Short description: DMII renl nt st uncntrld. ICD-9-CM 250.40 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 250.40 should only be used for claims with a date of service on or before September 30, 2015. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). You are viewing the 2012 version of ICD-9-CM 250.40. Convert to ICD-10-CM : 250.40 converts approximately to: 2015/16 ICD-10-CM E11.29 Type 2 diabetes mellitus with other diabetic kidney complication Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease stage 1 due to type 2 diabetes mellitus Chronic kidney disease stage 2 due to type 2 diabetes mellitus Chronic kidney disease stage 3 due to type 2 diabetes mellitus Chronic kidney disease stage 4 due to type 2 diabetes mellitus Chronic kidney disease stage 5 due to type 2 diabetes mellitus Chronic kidney disease with end stage renal disease on dialysis due to type 2 diabetes mellitus Chronic renal impairment associated with Type 2 diabetes mellitus Diabetes 2 with end stage renal disease on dialysis Diabetes type 2 with chronic kidney disease Diabetes type 2 with diabetic proteinuria Diabetes type 2 with kidney complications Diabetes type 2 with mild chronic kidney disease Diabetes type 2 with moderate kidney disease Diabetes type 2 with severe kidney disease Diabetes type 2, mild chronic kidney disease Diabetes type 2, moderate chronic kidney disease Diabetes type 2, severe chronic kidney disease Diabetic chronic renal impairment associated with Type 2 diabetes mellitus (disorder) Diabetic stage 1 chronic renal impairment associated with Type 2 Continue reading >>
Icd-10 Diagnosis Code E11.22
Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease due to type 2 diabetes mellitus Chronic kidney disease stage 1 due to type 2 diabetes mellitus Chronic kidney disease stage 2 due to type 2 diabetes mellitus Chronic kidney disease stage 2 due to type 2 diabetes mellitus Chronic kidney disease stage 3 due to type 2 diabetes mellitus Chronic kidney disease stage 3 due to type 2 diabetes mellitus Chronic kidney disease stage 4 due to type 2 diabetes mellitus Chronic kidney disease stage 4 due to type 2 diabetes mellitus Chronic kidney disease stage 5 due to type 2 diabetes mellitus Chronic kidney disease stage 5 due to type 2 diabetes mellitus End stage renal disease on dialysis due to type 2 diabetes mellitus End stage renal disease on dialysis due to type 2 diabetes mellitus Hypertension concurrent and due to end stage renal disease on dialysis Hypertension concurrent and due to end stage renal disease on dialysis due to type 2 diabetes mellitus Hypertension in chronic kidney disease due to type 2 diabetes mellitus Hypertension in chronic kidney disease stage 2 due to type 2 diabetes mellitus Hypertension in chronic kidney disease stage 3 due to type 2 diabetes mellitus Hypertension in chronic kidney disease stage 4 due to type 2 diabetes mellitus Hypertension in chronic kidney disease stage 5 due to type 2 diabetes mellitus References found for the code E11.22 in the Index of Diseases and Injuries: Diabetes means your blood glucose, or blood sugar, levels are too high. With type 2 diabetes, the more common type, your body doe Continue reading >>
How To Code Htn, Dm, Chf & Ckd
Mr. Jones presents to home health following a hospitalization for CHF exacerbation. His home Lasix dosage has been doubled. His medical history includes HTN, chronic systolic heart failure, DM and CKD stage 3. How would you code this? M1021a: I13.0 - Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease M1023b: I50.22 - Chronic systolic (congestive) heart failure M1023c: E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease M1023d: N18.3 - Chronic kidney disease, stage 3 (moderate) These 4 diagnoses must be grouped together and the sequencing guidance for each code must be followed. You will find a use additional code notes in the tabular index when you look at I13.0 and E11.22. You will also find a code first note when you look up I50.22 and N18.3 in the tabular index. Lets take a look at what the official coding guidelines say about these notes: Code first and Use additional code notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/ manifestation combination. So lets look at all of the rules that must be followed and the possible sequencing: N18.3 & I50.22 must be coded after the I13.- Following these rules, there are a few ways to sequence this properly: Continue reading >>
