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 c Continue reading

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A Diabetes Monitor That Spares the Fingers

For the past year and a half I’ve been buying a medical device from Italy that has improved my life immeasurably. It wasn’t easy: I roped in a good friend who had moved to Milan to buy the device and ship it to me because it wasn’t yet available in the States. And it was expensive: over $1,600 a year.
But my black-market purchase helps me manage my Type 1 diabetes without the need to draw blood from my callused fingers 10-plus times a day to track my glucose level, a ritual that had been an unpleasant part of my life for decades.
The FreeStyle Libre, made by Abbott, is a flash glucose sensor that allows people with diabetes to view our blood sugar every minute of the day without a single finger prick. While there are similar devices on the market — called continuous glucose monitors, or CGMs — the Libre is the least invasive one I’ve seen. It takes readings from a sensor under the skin but doesn’t require finger sticks for calibration, and is about the size of a quarter and as thick as two. And it’s helping me keep my diabetes under better control.
There have been some challenges: The Milanese UPS store wanted a letter detailing exactly what was in the box. My credit card’s fraud department called (“Yes, the charge for $365 from Milan is mine”).
So I was thrilled to learn that the Food and Drug Administration recently approved the sale of the Libre in the United States, a decision that may help some of the 29 million Americans with diabetes.
The Libre I buy from Italy has a self-adhesive, waterproof white sensor that sticks to my arm for 14 days. It to Continue reading

Native Americans with Diabetes

Native Americans (American Indians and Alaska Natives) have a greater chance of having diabetes than any other US racial group. Diabetes is the leading cause of kidney failure, a costly condition that requires dialysis or kidney transplant for survival. Kidney failure can be delayed or prevented by controlling blood pressure and blood sugar and by taking medicines that protect the kidneys. Good diabetes care includes regular kidney testing and education about kidney disease and treatment. Kidney failure from diabetes among Native Americans was the highest of any race. However, this has declined the fastest since the Indian Health Service (IHS) began using population health and team-based approaches to diabetes and kidney care, a potential model for other populations.
Health care systems can:
Use population health approaches to diabetes care. Assess long-term outcomes and address disparities. Promote wellness of the entire community and connect people to local resources, including healthy food, transportation, housing, and mental health care.
Develop a coordinated team approach to diabetes care. Team based-care should include patient education, community outreach, care coordination, tracking of health outcomes, and access to healthcare providers, nutritionists, diabetes educators, pharmacists, community health workers, and behavioral health clinicians.
Integrate kidney disease prevention and education into routine diabetes care. Screen people with diabetes for kidney disease and make sure that kidney disease is routinely addressed as part of diabetes care.
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Johnson & Johnson, Viacyte testing possible diabetes cure

Johnson & Johnson, continuing its long quest for a Type 1 diabetes cure, is joining forces with biotech company ViaCyte to speed development of the first stem cell treatment that could fix the life-threatening hormonal disorder.
They've already begun testing it in a small number of diabetic patients. If it works as well in patients as it has in animals, it would amount to a cure, ending the need for frequent insulin injections and blood sugar testing.
ViaCyte and Johnson & Johnson's Janssen BetaLogics group said Thursday they've agreed to combine their knowledge and hundreds of patents on their research under ViaCyte, a longtime J&J partner focused on regenerative medicine.
The therapy involves inducing embryonic stem cells in a lab dish to turn into insulin-producing cells, then putting them inside a small capsule that is implanted under the skin. The capsule protects the cells from the immune system, which otherwise would attack them as invaders - a roadblock that has stymied other research projects.
Researchers at universities and other drug companies also are working toward a diabetes cure, using various strategies. But according to ViaCyte and others, this treatment is the first tested in patients.
If the project succeeds, the product could be available in several years for Type 1 diabetes patients and down the road could also treat insulin-using Type 2 diabetics.
"This one is potentially the real deal," said Dr. Tom Donner, director of the diabetes center at Johns Hopkins University School of Medicine. "It's like making a new pancreas that makes all the hormones" need Continue reading

About Diabetes Type 3

Diabetes Type 3—which is regarded as “brain” specific diabetes—is a dangerous diabetes hybrid that was first discovered in 2005. A study, which was conducted at Brown University Medical School, suggests the brain produces insulin in a way that’s similar to the pancreas. A problem with insulin production in the brain is thought to result in the formation of protein “plaque”—not unlike that which is found among suffers of Type 1 (insulin-dependant) and Type 2 diabetes (insulin-resistant). But in the case of diabetes Type 3, plaque appears in the brain and leads to memory loss and problems forming memories.
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When it comes to the body, insulin is responsible for helping to convert food to energy. The brain uses insulin, too, but it’s thought insulin’s primary purpose in the brain is to form memories at synapses (the spaces where cells in the brain communicate), notes Time.com. Neurons save space for insulin receptors; insulin makes way for memories to form. In order for the brain to keep making more brain cells, it needs insulin. When insulin receptors flee—as is the case with sufferers of diabetes Type 3—the brain does not receive the energy it needs to form memories.
Alzheimer’s Connection
According to a research team at Northwestern University, insulin may prevent or slow memory loss among those with Alzheimer’s disease by protecting the synapses that form memory. Those with the disease tend to have lower insulin levels and are insulin-resistant. The team found that the reason memory fails when insulin shortage occurs is because am Continue reading