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 >>
2018 Icd-10-cm Diagnosis Code E08
E08- Diabetes mellitus due to underlying condition Diabetes mellitus due to underlying condition 2016 2017 2018 Non-Billable/Non-Specific Code E08 should not be used for reimbursement purposes as there are multiple codes below it that contain a greater level of detail . The 2018 edition of ICD-10-CM E08 became effective on October 1, 2017. This is the American ICD-10-CM version of E08 - other international versions of ICD-10 E08 may differ. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition. 2016 2017 2018 Billable/Specific Code POA Exempt Long term (current) use of oral hypoglycemic drugs 2017 - New Code 2018 Billable/Specific Code POA Exempt Long term (current) use of oral antidiabetic drugs Long term (current) use of oral hypoglycemic drugs 2017 - New Code 2018 Billable/Specific Code POA Exempt Long term (current) use of Continue reading >>
Hit220.221 Coding Handbook Chapter 15 - Endocrine, Nutritional And Metabolic Diseases (updated 2017)
HIT220.221 Coding Handbook Chapter 15 - Endocrine, Nutritional and Metabolic Diseases (Updated 2017) Hello, today we're going to start Chapter 15, Endocrine, Nutritional and Metabolic Diseases in our Coding Handbook which corresponds to Chapter 4 in our ICD-10-CM Code Book. This chapter includes diabetes which is probably one of the more common diagnosis you're going to see in the hospital. So we're going to spend quite a bit of time talking about diabetes and different manifestations of that. As a reminder, as you go through the Coding Handbook you're going to see several examples of procedures coding just ignore those. As we've talked about in the past just as a reminder ICD-10-PCS is taught in HIT231. It's a different Code Book, it's a different format. It's a totally different language that you're learning, however, if you do decide that you want to become a coder down the road, you are going to have to know ICD-10-CM, which is this course, ICD-10-PCS which is HIT231 and the CPT Book which is HIT241. All three of those languages, if you will, are on the CCS exam. So, just as a reminder there. As an overview of the types of diabetes that you're going to be coding Type 1, it's often called juvenile diabetes, but it really has nothing to do with the age of the patient. This type of diabetes is "characterized by the body's failure to produce any insulin", so we do not add code Z79.4 for long term use of insulin for patients with a Type 1 diabetes because they need that insulin to stay alive, so, we just assume that they are getting that insulin and it is not coded with a Type 1. Type 2, the body is producing insulin but it's not enough, or what it's producing is not sufficient in quality to be able to manage the glucose in the body. Those patients need the insulin and Continue reading >>
- Coding Diabetes: Time to Look at the Coding Guidelines Again
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
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 >>
Icd10 Code For Diabetes Pancreatic Cancer
Oct 4, 2015 . Here, it is important to code the underlying condition FIRST: Congenital rubella (P35.0); Cushing's syndrome (E24.-); Cystic fibrosis (E84.-); Malignant neoplasm (C00-C96); Malnutrition (E40-E46); Pancreatitis and other diseases of the pancreas (K85-K86.-). E09 - Drug or Chemical induced diabetes. chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event. (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, poisoning). Coding Guideline I.C.4.a.6.b. This category is reserved for individuals who develop diabetes mellitus as the result of an underlying condition such as malignancy, malnutrition, and pancreatitis. E09, Drug or chemical induced diabetes mellitus, will not be encountered often in primary care. When it is, the provider would first code the poisoning due to a. Diagnosis Code E08.9 information, including descriptions, synonyms, code edits, diagnostic related groups, ICD-9 conversion and references to the diseases index. chemical induced diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition or event. (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, poisoning). Coding Guideline I.C.4.a.6.b. ICD-10-CM Codes; ; E00-E89 Endocrine, nutritional and metabolic diseases; ; E08-E13 Diabetes mellitus; . Diabetes mellitus due to underlying condition E08- >. Use Additional. Use Additional Help. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying. chemical induced diabetes mellitus, id Continue reading >>
Icd-10 Diagnosis Code E08.9
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes. Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes. Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Blood sugar test - blood (Medical Encyclopedia) Choose More than 50 Ways to Prevent Type 2 Diabetes - NIH - Easy-to-Read (National Diabetes Education Program) Diabetes - keeping active (Medical Encyclopedia) Diabetes - low blood sugar - self-care (Medical Encyclopedia) Diabetes - tests and checkups (Medical Encyclopedia) Diabetes - when you are sick (Medical Encyclopedia) Diabetes and exercise (Medical Encyclopedia) Giving an insulin injection (Medical Encyclopedia) If you have diabetes, your blood glucose, or blood sugar, levels are too high. Continue reading >>
Diabetes And Pancreatic Cancer
Go to: Prevalence of diabetes in pancreatic cancer Numerous studies have reported the prevalence of diabetes in cancer in general and pancreatic cancer in particular. In studying prevalence, researches have taken a number of different approaches in defining the presence of diabetes in cases of controls. These include physician-recorded diagnosis of diabetes, International Classification of Diseases (ICD) codes for diabetes, self-reported diabetes by patients answering a questionnaire, patients on anti-diabetes medicationsa and laboratory records showing elevated fasting blood glucose values and elevated glycosylated hemoglobin values. Few studies have prospectively screened patients for diabetes using glucose tolerance tests or measuring fasting glucose values. The prevalence of diabetes in pancreatic cancer has varied considerably (from 4% to 65%) in reported studies, variability that has largely resulted in ascertainment of diabetes noted above. In retrospective studies of medical records and studies relying on self-reported diabetes, the prevalence of diabetes in pancreatic cancer has varied from 4% to 20%.5 A recently published study using medical records to identify diabetes reported the prevalence of diabetes in pancreatic cancer to be 10% which was no different from that seen in the control non-cancer subjects.6 On the other hand, in studies where patients with pancreatic cancer were prospectively screened for diabetes or where fasting blood glucose data on patients was reviewed, the prevalence of diabetes has been shown to be very high (45% and 75%),7–9 a prevalence many times greater than that reported in the general population. A study by Permert et al.7 using glucose tolerance tests in patients with newly diagnosed pancreatic cancer showed that 75% of patie Continue reading >>
Diabetes Coding Medesun Icd-10-cm 2017 By Medesun Medical Coding Training Center - Issuu
Diabetes codes in ICD-10-CM are combination codes, includesType of diabetesBody System InvolvedComplicationExample:E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macularedemaE10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene If the type of diabetes is not mentioned in the documentation, query the physician orassign the code E11.Assign the code Z79.4 for long term use of insulinIf insulin is given on temporary basis, dont assign the code Z79.4 ICD-10-CM 2017The first major change in ICD-10-CM codes for 2017 is for diabetic ocular complicationcoding. All of the DM retinopathy code choices will now specify which eye is impacted.Several new codes for proliferative diabetic retinopathy were also added.Laterality is now a component of all diabetic retinopathy and macular edema codes.For patients who routinely use insulin or hypoglycaemic drugs, code Z79.4, Long-term(current) use of insulin, or Z79.84, Long term (current) use of oral hypoglycemic drugsshould also be assigned.If a patient is on both oral medication and insulin, both of these medication codesshould be usedE10.32 Type 1 diabetes mellitus with mild nonproliferative diabeticretinopathy Type 1 diabetes mellitus with nonproliferative diabetic retinopathy NOSOne of the following 7th characters is to be assigned to codes in subcategory E10.32 todesignate laterality of the disease:1 - right eye2 - left eye3 - bilateral9 - unspecified eyeWith implementation of 2017 ICD-10, coding diabetic patients with ophthalmicmanifestations frequently requires a seventh digit to indicate which eye is involved. Forexample,E11.34 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathyOne of the following 7th characters is to be assigned to codes in subcatego Continue reading >>
Icd-10 Training: Coding For Diabetes
Diabetes mellitus coding under ICD-10 will require documentation with greater specificity and detail 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 ma Continue reading >>
Pancreatic Cancer: Practice Essentials, Background, Pathophysiology
Pancreatic cancer is the fourth leading cause of cancer deaths, being responsible for 7% of all cancer-related deaths in both men and women. Approximately 75% of all pancreatic carcinomas occur within the head or neck of the pancreas, 15-20% occur in the body of the pancreas, and 5-10% occur in the tail. See the image below. Pancreatic cancer. Gross section of an adenocarcinoma of the pancreas measuring 5 X 6 cm resected from the pancreatic body and tail. Although the tumor was considered to have been fully resected and had not spread to any nodes, the patient died of recurrent cancer within 1 year. The initial symptoms of pancreatic cancer are often quite nonspecific and subtle in onset. Patients typically report the gradual onset of nonspecific symptoms such as anorexia, malaise, nausea, fatigue, and midepigastric or back pain. Patients with pancreatic cancer may present with the following signs and symptoms: Significant weight loss: Characteristic feature of pancreatic cancer Midepigastric pain: Common symptom of pancreatic cancer, sometimes with radiation of the pain to the midback or lower-back region Often, unrelenting pain: Nighttime pain often a predominant complaint Onset of diabetes mellitus within the previous year Painless obstructive jaundice: Most characteristic sign of cancer of head of the pancreas Pruritus: Often the patient's most distressing symptom Migratory thrombophlebitis (ie, Trousseau sign) and venous thrombosis: May be the first presentation Palpable gallbladder (ie, Courvoisier sign) Developing, advanced intra-abdominal disease: Presence of ascites, a palpable abdominal mass, hepatomegaly from liver metastases, or splenomegaly from portal vein obstruction Advanced disease: Paraumbilical subcutaneous metastases (or Sister Mary Joseph nodule or Continue reading >>
Coding Guidelines For Diabetes Under Icd-10 | Acdis Blog
Book Excerpt: Coding guidelines for diabetes under ICD-10 The age of a patient is not the sole determining factor for the type of diabetes, although most Type 1 diabetics develop the condition before reaching puberty. For this reason, Type 1 diabetes mellitus is also referred to as juvenile diabetes. If the physician does not document the type of diabetes mellitus in the medical record, the default category of codes is E11 (type 2 diabetes mellitus). If the physician does not document the type of diabetes but does indicate that the patient uses insulin, assign a code from category E11; also report code Z79.4, long term (current use insulin to indicate that the patient uses insulin. Do not report code Z79.4 if a Type 2 patient is given insulin temporarily to bring his or her blood sugar under control during an encounter. In situations where diabetes occurs during pregnancy and for cases of gestational diabetes, refer to the ICD-10 Official Guidelines for Coding and Reporting Section I.C.15, Diabetes mellitus in pregnancy and gestational (pregnancy-induced) diabetes. The codes under category E08 (diabetes mellitus due to underlying condition) and E09 (drug or chemical induced diabetes mellitus) identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes is always caused by another condition of event (e.g., cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drugs, poisoning.) The sequencing of the secondary diabetes codes in relation to codes for the cause of the diabetes is based on the tabular instructions for categories E08 and E09. For category E08, first code the underlying condition. For category E09 first code the drug or chemical (T36-T65). For a patient with diabetes ketoacidosis without co Continue reading >>
Secondary Diabetes Mellitus Coding
A thorough understanding will be required for ICD-10-CM coding. With the epidemic of diabetes in the U.S. and more Americans being diagnosed with the condition than ever before, the need for more specific diagnosis codes to represent the various forms of the disease has significantly increased. In 2008, 20 new diagnosis codes were released to track secondary diabetes, defined as a diabetic condition whose underlying cause is not genetics or environmental conditions. Coders are required to determine the specific manifestation of the disease (e.g., diabetic nephropathy, retinopathy, ketoacidosis, etc.), whether it is considered to be in a controlled or uncontrolled state, and also the underlying etiology of the disease. This will require medical staff education on the need for specific documentation related to diabetes causes. In addition, coding staff and physicians should prepare for much more specificity in diabetes coding after implementation of ICD-10-CM. The ICD-9-CM secondary diagnosis codes are as follows: Secondary diabetes mellitus w/o mention of complication, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with ketoacidosis, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with hyperosmolarity, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with other coma, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with renal manifestations, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with ophthalmic manifestations, [not stated as uncontrolled, or unspecified/uncontrolled] Secondary diabetes mellitus with neurological manifestations, [not stated as uncontrolled, or unspecified/unc Continue reading >>
Help With Diagnosis Coding Diabetes
If this is your first visit, be sure to check out the FAQ & read the forum rules . To view all forums, post or create a new thread, you must be an AAPC Member . If you are a member and have already registered for member area and forum access , you can log in by clicking here . If you've forgotten your username or password use our password reminder tool . To start viewing messages, select the forum that you want to visit from the selection below. How would you code Diabetes Mellitus coma due to malignant neoplasm of the pancreatic duct? I saw this on a test. Would you code 249.30, 157.3 or the other way around 157.3, 249.30? What is the reasoning for your decision? Thank you I would code 249.30, 157.3 because the neoplasm is what caused the diabetic coma so it should be sequenced second. read the diagnosis guidelines for secondary diabetes and sequencing. ICD-9 is different from ICD-10 on this. By [email protected] in forum Medical Coding General Discussion By kmelling in forum Medical Coding General Discussion By kumeena in forum Medical Coding General Discussion AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals. In addition to full participation on AAPC forums, as a member you will be able to: Access to the largest healthcare job database in the world. Join over 150,000 members of the healthcare network in the world. Be a part of an industry leading organization that drives the business side of healthcare. Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences. Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members a Continue reading >>
Icd-10 Diagnosis Code E08
Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. You can also have prediabetes. This means that your blood sugar is higher than normal but not high enough to be called diabetes. Having prediabetes puts you at a higher risk of getting type 2 diabetes. Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes. Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your blood glucose level and take medicine if prescribed. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Blood sugar test - blood (Medical Encyclopedia) Choose More than 50 Ways to Prevent Type 2 Diabetes - NIH - Easy-to-Read (National Diabetes Education Program) Diabetes - keeping active (Medical Encyclopedia) Diabetes - low blood sugar - self-care (Medical Encyclopedia) Diabetes - tests and checkups (Medical Encyclopedia) Diabetes - when you are sick (Medical Encyclopedia) Diabetes and exercise (Medical Encyclopedia) Giving an insulin injection (Medical Encyclopedia) Continue reading >>
2012 Icd-9-cm Diagnosis Code 249.80 : Secondary Diabetes Mellitus With Other Specified Manifestations, Not Stated As Uncontrolled, Or Unspecified
Secondary diabetes mellitus with other specified manifestations, not stated as uncontrolled, or unspecified Short description: Sec DM oth nt st uncontr. ICD-9-CM 249.80 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 249.80 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 249.80. Convert to ICD-10-CM : 249.80 converts approximately to: 2015/16 ICD-10-CM E08.618 Diabetes mellitus due to underlying condition with other diabetic arthropathy 2015/16 ICD-10-CM E08.620 Diabetes mellitus due to underlying condition with diabetic dermatitis 2015/16 ICD-10-CM E08.621 Diabetes mellitus due to underlying condition with foot ulcer 2015/16 ICD-10-CM E08.622 Diabetes mellitus due to underlying condition with other skin ulcer 2015/16 ICD-10-CM E08.628 Diabetes mellitus due to underlying condition with other skin complications 2015/16 ICD-10-CM E08.630 Diabetes mellitus due to underlying condition with periodontal disease 2015/16 ICD-10-CM E08.638 Diabetes mellitus due to underlying condition with other oral complications 2015/16 ICD-10-CM E08.65 Diabetes mellitus due to underlying condition with hyperglycemia 2015/16 ICD-10-CM E08.69 Diabetes mellitus due to underlying condition with other specified complication 2015/16 ICD-10-CM E09.618 Drug or chemical induced diabetes mellitus with other diabetic arthropathy 2015/16 ICD-10-CM E09.620 Drug or chemical induced diabetes mellitus with diabetic dermatitis 2015/16 ICD-10-CM E09.621 Drug or chemical induced diabetes mellitus with foot ulcer 2015/16 ICD-10-CM E09.622 Drug or chemical induced diabe Continue reading >>
