Top Icd-10-cm Changes: Diabetes, Glaucoma And Macular Degeneration
On October 1, 2016, changes to ICD-10-CM coding were implemented. While all of the code changes applicable for optometry are important, a few of the major changes are discussed in this article. Diabetic Ocular Complication Codes The first major change in ICD-10-CM codes for 2017 is for diabetic ocular complication coding. All of the DM retinopathy code choices will now specify which eye is impacted. Several new codes for proliferative diabetic retinopathy were also added. Note that a code for oral diabetic medication use (Z79.84) was added and should be used when applicable. The existing code to designate insulin use (Z79.4) was retained. Keep in mind that not all injectable diabetic medications are considered insulin. If a patient is on both oral medication and insulin, both of these medication codes should be used. The new codes for diabetic retinopathy apply to all the code categories, but only the E11.3 code section is detailed in this article so be sure to review the other categories if you are using them for any particular patient. The other categories include E08.3, E09.3, and E10.3. E11.3 Type 2 diabetes mellitus with ophthalmic complications All of the subcategories under E11.3, with two exceptions, will require a 7th character to indicate which eye had retinopathy. One exception is E11.36 Type 2 diabetes mellitus with diabetic cataract. The other exception is E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication, but this code does require the use of an additional code to further describe the complication. The ICD-10-CM tabular listing for each of the following subcategories will require the following 7th character to be added as indicated by this statement under each subcategory: E11.32, E11.33, E11.34, and E11.35. As an example, all of Continue reading >>
Icd-10 Codes For Diabetes
There's More Than One Type Of Diabetes... I'm pretty sure all of you who made it thus far in this article are familiar with the fact that there are at least two major types of diabetes: type I, or juvenile, and type II, with usual (though not mandatory) adult onset. Just like ICD-9, ICD-10 has different chapters for the different types of diabetes. The table below presents the major types of diabetes, by chapters, in both ICD coding versions. Diabetes Coding Comparison ICD-9-CM ICD-10-CM 249._ - Secondary diabetes mellitus E08._ - Diabetes mellitus due to underlying condition E09._ - Drug or chemical induced diabetes mellitus E13._ - Other specified diabetes mellitus 250._ - Diabetes mellitus E10._ - Type 1 diabetes mellitus E11._ - Type 2 diabetes mellitus 648._ - Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium O24._ - Gestational diabetes mellitus in pregnancy 775.1 - Neonatal diabetes mellitus P70.2 - Neonatal diabetes mellitus This coding structure for diabetes in ICD-10 is very important to understand and remember, as it is virtually always the starting point in assigning codes for all patient encounters seen and treated for diabetes. How To Code in ICD-10 For Diabetes 1. Determine Diabetes Category Again, "category" here refers to the four major groups above (not just to type 1 or 2 diabetes): 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 Note that, for some reason, E12 has been skipped. Instructions on Diabetes Categories Here are some basic instructions on how to code for each of the diabetes categories above: E08 - Diabetes mellitus due to underlying condition. Here, it is Continue reading >>
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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 >>
Retina Today - New Uses Of The 7th Character In Icd-10-cm Coding (january/february 2017)
In the March 2016 issue of Retina Today, I delved into the preliminary coding quandaries relating to using the 7th character with the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).1 In the 2017 version of that book of diagnosis codes, several new uses have been introduced that pertain specifically to retina coding.2 It is imperative to incorporate these changes in your coding, lest claim denials increase. There are more than 60 new codes requiring the 7th character in Chapter 4 of the 2017 ICD-10-CM codebook, which contains many of the new codes involving the levels of diabetic retinopathy and concurrent diagnoses: for example, E11.331- Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema. Note that in this article the hyphen (-) at the end of a series of characters indicates that another character is needed. Perusing the ICD-10-CM book for E11.331- reveals that a 7th character must be used to indicate laterality. Chapter 7 includes different kinds of 7th character mandates. This article explains new uses of the 7th character for 2017. The length of ICD-10-CM diagnosis codes can range from four to seven characters; however, instructions indicate that when a 7th character is to be used it must be positioned as the 7th character. If a code has less than six characters, then one or more placeholders must be inserted before the 7th character. Specific instructions in ICD-10-CM state that certain categories have applicable 7th character extensions. In these cases, the 7th character extension is required for all codes within the category, or as otherwise instructed in the tabular list notations. 7th character extensions must always be the last character in the data field. If a code is not a f Continue reading >>
Is Icd-10 The Holy Grail For Disease Management?
Is ICD-10 the Holy Grail for Disease Management? Producing data richer than a triple chocolate layer cake, ICD-10 has the potential to boost the care and treatment of todays most pressing health concerns. The International Classification of Diseases (ICD), a complex scheme of classifying diseases, has been referred to as the link to international healthcare collaboration. Care and disease managementknowledge about disease causes, cures, and optimal treatment patternsis an international pursuit void of political boundaries and bias. For example, global adoption of ICD-10 could have more quickly determined the expansion and impact of the West Nile virus and severe acute respiratory syndrome (better known as SARS), leading to earlier detection and improved tracking. Although it appears likely that the effective date for implementation will be pushed back one year to October 1, 2014, US healthcare regulators have mandated that every provider and payer organization institute ICD-10 codes. The order, which has been referred to as a tsunami of change and compared with the Y2K debacle, will be the only method for disease classification, standardized treatments, and international data sharing. It will also play a huge role in improving the accuracy of provider reimbursements. Over time, the change should be well worth the cost for physicians, researchers, disease management organizations, patient-centered medical homes and, of course, patients. ICD-10 codes have a vastly greater level of detail than that provided by the current ICD-9 codes. ICD-10 will allow physicians to expect better matching of payment for their work effort, more accurate risk adjustment in any bundled payment system, and increased payments under pay-for-performance plans. During an appointment, a physician Continue reading >>
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 >>
Diabetes Mellitus Icd-10 Case Study | Practice Fusion
A 40-year-old male presents in his physicians office with complaints of new onset of excessive thirst, urinary frequency and fatigue. His physician ran several tests and based on the results he diagnosed his patient with Type 2 diabetes mellitus. The value of describing patient conditions with ICD-10 codes as compared to ICD-9 codes is made evident when comparing codes available for specific conditions. A common disease affecting millions of patients is diabetes mellitus. According to the American Diabetes Association, Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. In spite of the significant prevalence of this disease, ICD-9 codes describing this condition lack specificity, resulting in the lumping of many patients into broad categories that are not as useful for comparisons and quality measures as ICD-10 codes will be once implemented. Patients with diabetes mellitus are most often described with two ICD-9 codes. ICD-9 codes in the 250xx series describe primary diabetes of all types. Codes in the 249xx group describe secondary diabetes without information regarding the underlying cause of the diabetes. Each series includes a general description of a few complications that may be associated with this disease without detailed descriptions of those complications. These codes lack the specificity necessary to fully document patients medical conditions. The ICD-10 Index includes approximately six pages of specific listings for diabetes and its various clinical manifestations. Almost all of Continue reading >>
Icd Tips And Resources Newsletter Issue 43 Dated January 10, 2014
The codes for diabetes mellitus have expanded in ICD-10-CM into five categories of codes. The codes were made into combination codes that bundle in the type, the body system affected, and any complications of the body system. The five categories are as follows: E08Diabetes mellitus due to an underlying condition E09Drug or chemically induced diabetes mellitus Notice that there is no unspecified diabetes mellitus code category. According to the guidelines (I.C.4.a.2), if the type of diabetes mellitus is not documented in the medical record the default is E11, Type 2 diabetes mellitus. John comes in to the clinic for a check up on his chronic conditions. The physician documents "diabetes" as the assessment with no further specification in the note. E11.9Type 2 diabetes mellitus without complications The differences from ICD-9-CM include the fact that the codes do not include "uncontrolled" and "not stated as uncontrolled" in the descriptors any longer. Instead, the codes are listed as with and without complications. The second difference is the combination of the complication into the code. The subcategories are broken down for the complications with the body systems affected by diabetes mellitus as follows: Definitions for the types of diabetes mellitus are located in the "Includes notes" under each DM category. Physicians and other providers should be instructed to document the type of diabetes as type 1 or type 2, when appropriate, and not insulin and non-insulin dependent as these terms are no longer used in the coding schema. Paulette, a type 1 diabetic, comes in today for a recheck of her diabetic right heel ulcer. Upon examination, it is healing well, with the breakdown limited to the skin. E10.621Type 1 diabetes mellitus with foot ulcer L97.411Non-pressure chroni Continue reading >>
2018 Icd-10-cm Codes E08-e13: Diabetes Mellitus
E08 Diabetes mellitus due to underlying condition... E08.0 Diabetes mellitus due to underlying condition... E08.00 Diabetes mellitus due to underlying condition... E08.01 Diabetes mellitus due to underlying condition... E08.1 Diabetes mellitus due to underlying condition... E08.10 Diabetes mellitus due to underlying condition... E08.11 Diabetes mellitus due to underlying condition... E08.2 Diabetes mellitus due to underlying condition... E08.21 Diabetes mellitus due to underlying condition... E08.22 Diabetes mellitus due to underlying condition... E08.29 Diabetes mellitus due to underlying condition... E08.3 Diabetes mellitus due to underlying condition... E08.31 Diabetes mellitus due to underlying condition... E08.311 Diabetes mellitus due to underlying condition... E08.319 Diabetes mellitus due to underlying condition... E08.32 Diabetes mellitus due to underlying condition... E08.321 Diabetes mellitus due to underlying condition... E08.3211 Diabetes mellitus due to underlying condition... E08.3212 Diabetes mellitus due to underlying condition... E08.3213 Diabetes mellitus due to underlying condition... E08.3219 Diabetes mellitus due to underlying condition... E08.329 Diabetes mellitus due to underlying condition... E08.3291 Diabetes mellitus due to underlying condition... E08.3292 Diabetes mellitus due to underlying condition... E08.3293 Diabetes mellitus due to underlying condition... E08.3299 Diabetes mellitus due to underlying condition... E08.33 Diabetes mellitus due to underlying condition... E08.331 Diabetes mellitus due to underlying condition... E08.3311 Diabetes mellitus due to underlying condition... E08.3312 Diabetes mellitus due to underlying condition... E08.3313 Diabetes mellitus due to underlying condition... E08.3319 Diabetes mellitus due to underlyin Continue reading >>
(pdf) Coding Diabetes Mellitus In Icd-10-cm: Improved Coding For Diabetes Mellitus Complements Present Medical Science
ImportancePatient adherence to antidiabetic medications, especially insulin, remains poor, leading to adverse outcomes and increased costs. Most adherence interventions have only been modestly effective, partly because they are not targeted to patients who could benefit most.ObjectiveTo evaluate whether delivering more intensive insulin-adherence interventions only to individuals with type 2 diabetes predicted to benefit most was more effective than delivering a lower-intensity intervention to a larger group of unselected individuals.Design, Setting, and ParticipantsThis 3-arm pragmatic randomized clinical trial used data from Horizon, the largest health insurer in New Jersey, on 6000 participants 18 years or older with type 2 diabetes who were receiving basal insulin. Patients were excluded if they were insured by Medicaid or Medicare or had fewer than 3 months of continuous enrollment. The study was conducted from July 7, 2016, through October 5, 2017. Analyses were conducted from February 5 to September 24, 2018.InterventionsEligible patients were randomized to 3 arms in a 1:1:1 ratio. Randomization was stratified based on baseline availability of 1 or more glycated hemoglobin A1c (HbA1c) test values. All arms were designed to cost the same, and each cohort received a tailored pharmacist telephone consultation varying based on (1) proportion receiving the intervention and (2) intensity, including follow-up frequency and cointerventions. Arm 1 offered a low-intensity intervention to all patients. Arm 2 offered a moderate-intensity intervention to 60% of patients based on their predicted risk of insulin nonadherence. Arm 3 offered a high-intensity intervention to 40% of patients based on glycemic control and predicted risk of insulin nonadherence.Main Outcomes and Mea Continue reading >>
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 >>
Icd-10-cm: Brace Yourself For 5 Highly Specific Diabetes Categories
Use this handy bullet list for stellar diabetes documentation. Diabetes is a common diagnosis that coders from all specialties, from wound care to ophthalmology, need to understand. In ICD-9-CM, you find the diabetes codes in category 250.xx, which covers both Type 1 and Type 2 diabetes. However, starting October 1, 2015, when the nation moves over to ICD-10-CM, diabetes coding will get a makeover. Youll report Type 1 diabetes with E10.- and Type 2 diabetes with E11.-. And thats just the tip of the iceberg. Lets take a look at how the new system changes the way you report diabetes. Shift Your Focus From Uncontrolled to Manifestations One key difference between ICD-9-CM and ICD-10-CM coding for diabetes revolves around the concept of controlled/uncontrolled diabetes. Currently, in ICD-9-CM, you need that information to select the proper fifth digit. For instance, note the end of the descriptor for 250.50 (Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled). ICD-10-CM does not use the language uncontrolled or not stated as uncontrolled for diabetes codes. Instead, the ICD-10-CM diabetes codes are combination codes that include: As an example, review the definition of E11.321 (Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema), noting the inclusion of the specific manifestation, retinopathy with macular edema, but no use of the term uncontrolled. As E11.321 reveals, while reporting diabetes in the new system, youll have to decipher whether the patient in question has any diabetic manifestations. The fourth character of a diabetes code (ranging from 0 to 9) indicates whether and what kind of manifestation a diabetic patient has. The fifth and sixth characters specify the manifestation. Continue reading >>
2018 Icd-10-cm Codes E11*: Type 2 Diabetes Mellitus
E08 Diabetes mellitus due to underlying condition... E08.0 Diabetes mellitus due to underlying condition... E08.00 Diabetes mellitus due to underlying condition... E08.01 Diabetes mellitus due to underlying condition... E08.1 Diabetes mellitus due to underlying condition... E08.10 Diabetes mellitus due to underlying condition... E08.11 Diabetes mellitus due to underlying condition... E08.2 Diabetes mellitus due to underlying condition... E08.21 Diabetes mellitus due to underlying condition... E08.22 Diabetes mellitus due to underlying condition... E08.29 Diabetes mellitus due to underlying condition... E08.3 Diabetes mellitus due to underlying condition... E08.31 Diabetes mellitus due to underlying condition... E08.311 Diabetes mellitus due to underlying condition... E08.319 Diabetes mellitus due to underlying condition... E08.32 Diabetes mellitus due to underlying condition... E08.321 Diabetes mellitus due to underlying condition... E08.3211 Diabetes mellitus due to underlying condition... E08.3212 Diabetes mellitus due to underlying condition... E08.3213 Diabetes mellitus due to underlying condition... E08.3219 Diabetes mellitus due to underlying condition... E08.329 Diabetes mellitus due to underlying condition... E08.3291 Diabetes mellitus due to underlying condition... E08.3292 Diabetes mellitus due to underlying condition... E08.3293 Diabetes mellitus due to underlying condition... E08.3299 Diabetes mellitus due to underlying condition... E08.33 Diabetes mellitus due to underlying condition... E08.331 Diabetes mellitus due to underlying condition... E08.3311 Diabetes mellitus due to underlying condition... E08.3312 Diabetes mellitus due to underlying condition... E08.3313 Diabetes mellitus due to underlying condition... E08.3319 Diabetes mellitus due to underlyin Continue reading >>
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Occ Coding Ch 6
Sort ICD-9-CM Categories 249-259 This section contains codes for Diabetes mellitus and Secondary diabetes mellitus Other disorders of pancreatic internal secretion Disorders of other endocrine glands Parathyroid Pituitary Thymus Adrenal Ovarian Testicular ICD-9-CM Diabetes Mellitus (continued) ICD-9-CM subcategory codes 250.0-250.9 Fourth-digit subcategories Identify the presence or absence of complications and/or manifestations 250.0 indicates no mention of complication 250.1, 250.2, 250.3 indicate a primary complication exists 250.4, 250.5, 250.6, 250.7, 250.8 indicate specific types of manifestations from diabetes 250.9 indicates unspecified complication ... Two types of diabetes: Type I and Type II Type I diabetes Previously described as insulin-dependent diabetes Also known as juvenile type Condition typically originates in childhood or young adult years Absolute lack of insulin production or absence of pancreatic beta cells Insulin must be administered Cause is unknown Less common form of diabetes; Type II more common ... Type II diabetes Previously described as non-insulin-dependent diabetes Also known as adult onset type Condition typically originates in older adults but has been diagnosed in younger people recently Lack of proper functioning of pancreatic beta cells Insulin not usually required but may be administered Risk factors include obesity and heredity but exact cause is unknown ... ICD-9-CM Fifth-digit subclassifications Fifth digit of "0" Type II Unspecified type - type I or II not stated in record Out-of-date terminology: non-insulin dependent, NIDDM, or adult onset diabetes Use if Type II patient requires insulin Not stated as "uncontrolled" Use additional code, if applicable, for associated long-term (current) insulin use, V58.67 If insulin is given Continue reading >>
A Closer Look: Documentation And Coding For Diabetes Diagnoses
In last month’s Blue Review, we took a closer look at documentation and coding for pulmonary diagnoses as part of our effort to provide more information that may help with the transition to ICD-10, Risk Adjustment and more. This month, we look at diabetes, a group of metabolic diseases that includes chronic and short-term conditions such as diabetes mellitus, gestational diabetes and impaired glucose tolerance. The conditions that fall under this category can sometimes be asystematic and other times can develop complications. It is imperative that documentation is specific and accurate to facilitate accurate, complete and compliant diagnosis code assignment. On October 1, 2014, the health care industry will transition from ICD-9-CM to ICD-10-CM/PCS for diagnoses and inpatient procedure coding. It is essential to take note of the key differences in coding in ICD-9-CM versus the ICD-10-CM/PCS code sets. The goal of this article is to review documentation and diagnosis coding for conditions that fall under the diabetes umbrella to achieve accurate and compliant practices. Diabetes Mellitus Diabetes mellitus (DM) is a disease in which the body fails to properly produce or use insulin. Diabetes mellitus is divided into two categories: Type 1, insulin-dependent DM (IDDM), previously referred to as “juvenile diabetes,” and Type 2, non-insulin-dependent DM (NIDDM) previously referred to as “adult-onset diabetes.” ICD-9-CM code structure classifies diabetes into a single code category, 250. Accurate code assignment required determination of specific fourth- and fifth-digit sub-classifications. The fourth digit provides details regarding the presence of manifestations or complications due to diabetes, while the fifth digit indicates whether the diabetes is controlled or Continue reading >>
