# Linking of Diabetes and Complications



## Goosie (Dec 1, 2015)

Has anything changed in the coding of Diabetes and the numerous complications that accompany it?

It used to be that the provider needed to *document a link *between the two in order to use a combination code.  An example would be: "Diabetes Type 2 with Retinopathy, Headache, Hypertension" (E11.3419, R51, I10), or "Diabetes Type 2, Retinopathy, Headache, Hypertension" (E11.9, H35.00, R51, I10).

Now that there is a Diabetes with Hyperglycemia code, our providers have been repeatedly diagnosing Hyperglycemia, and listing Diabetes Type 1 in the Personal Medical History, not linking them in any way. 

The problem is that I try to code appropriately and any comorbidities require coding, especially when they affect the care of the patient, but there is an Excludes 1 and Hyperglycemia cannot be coded with Diabetes Type 1, so despite the provider not linking the two, what do we do?  

Any thoughts would be appreciated.  Thanks!


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## Goosie (Dec 2, 2015)

*No, Really......   ANY THOUGHTS!!*


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## erjones147 (Dec 2, 2015)

Ask your docs if they have ever seen a situation when a known diabetic had a hyperglycemic episode NOT related to DM. WHEN (not if) the answer comes back, "No, of course not," you have your answer. Code the DM combo code


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## mitchellde (Dec 2, 2015)

The provider must link the conditions.. It is not enought that they tell you that they have never observed it befor.  The coder cannot make this determination based on a conversation.  If the do not link them then code the patients chronic condition of type 1 diabetes with no complications.


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## Goosie (Dec 2, 2015)

So, if the DM 1 is listed in PMH, and the provider lists Hyperglycemia as the Dx, I should code the DM 1, I assume because the DM 1 is never going away, but the Hyperglycemia will (or should), and I can't use both due to the Excludes 1.  

Thank you for the insight!


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## mitchellde (Dec 3, 2015)

Yes that is correct.  What does the body of the note state though.  That is here the coding comes from.  If hyperglycemia is not mentioned anywhere but in the diagnosis list, I have to wonder about that.


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## Squezzer78 (Dec 3, 2015)

*Coding Type 2 DM with other Type 2 DM codes*

You all may think this is a dumb question but I was wondering if anyone knows can you use E11.69 Type 2 DM with other specified complications and E11.29 Type 2 DM with other diabetic kidney complication. I don't think so but I am not 100% sure to me it is double diagnosing DM type 2. Any suggestions or thoughts?


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## cathya35 (Dec 3, 2015)

*Type 1 diabetes with hyperglycemia*

Type 1 diabetes with hyperglycemia is coded to E10.65. There is no longer an "uncontrolled" option for diabetes in ICD-10 and diabetes stated as uncontrolled is coded to diabetes by type with hyperglycemia. I would ask your docs if they mean type 1 diabetes with hyperglycemia (a different way to state uncontrolled type 1 diabetes). Hope that helps.


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## Goosie (Dec 3, 2015)

mitchellde said:


> Yes that is correct.  What does the body of the note state though.  That is here the coding comes from.  If hyperglycemia is not mentioned anywhere but in the diagnosis list, I have to wonder about that.


The HPI states High Blood Sugar.  The PMH states DM1.  There is a cut and paste of lab results showing Glucose of 331. The Dx is Hyperglycemia.  Asking the provider for information would be stepping on the Educator's toes, and explaining it to the Educator would be like explaining Einstein's Theory of Relativity to a newborn.   

Rock ----- Me ----- Hardplace


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## amoskovich (Dec 3, 2015)

331 blood sugar is very high for a patient with DM1. That is obvious uncontrolled DM. What did the provider document as treatment. higher  dose of Insulin or other DM meds leads you to a combo code


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## Goosie (Dec 3, 2015)

amoskovich said:


> 331 blood sugar is very high for a patient with DM1. That is obvious uncontrolled DM. What did the provider document as treatment. higher  dose of Insulin or other DM meds leads you to a combo code


Yes, 331 is high, but the provider did not link the hyperglycemia to DM1, and there is an excludes 1 between the two.  Provider gave insulin, rechecked glucose and sent home.  No changes to dosage, said to follow up with PCP.


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## amoskovich (Dec 3, 2015)

If the provider gave insulin that's the link. It's hyperglycemia in a patient with DM1. there is an excludes 1 because there is a combo code to use if both conditions are apparent - E10.65


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## Goosie (Dec 3, 2015)

Providers must link the diabetes with the complication.  If the excludes 1 is because of the existence of a combo code, why is there no excludes 1 for hyperglycemia on DM 2?  Patient's can have neuropathy and diabetes, but that does not mean they have diabetic neuropathy.  There has to be a linking of the two in the documentation. And giving insulin is not "the link". 

Thank you!  But I believe Debra Mitchell has the answer for me. (As coincidentally, she usually does!)


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## cathya35 (Dec 4, 2015)

*Hyperglycemia is inherent to type 1 diabetes*

You stated that the PMH states DM type 1 and HPI states high blood sugar and labs show BG of 331. I would use BG of 331 along with high blood sugar as TAMPER/MEAT for DM type 1 and stated hyperglycemia in diagnosis to code as E10.65. 

The excludes 1 note for hyperglycemia is listed under E10.9 because that code is for type 1 diabetes without complications and hyperglycemia is a complication. I'm not sure why there isn't an excludes 1 note for hyperglycemia under E11.9 for type 2 diabetes, but there is an excludes 1 note for diabetes mellitus (E08-E13), which includes type 2 diabetes, under the code for hyperglycemia (R73.9). 

Hyperglycemia is inherent to type 1 diabetes, so I don't believe it needs to be specifically stated as due to type 1 diabetes. What else would be the cause for hyperglycemia other than the type 1 diabetes? For other complications of diabetes, such as neuropathy, there could be other causes, but not for hyperglycemia.


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## mitchellde (Dec 4, 2015)

The note is rather skimpy and does not give much information.  Be careful about reading too much into the documentation as a coder.  While it is ok to know a few things you cannot code based on that knowledge.  The provider does need to link the hyperglycemia as a complication of the diabetes.  For one thing it does not state this was a fasting result.  no other symptoms are noted, so it could be the result of a dietary issue.  It is not known nor documented.  The only thing we do know is that the patient is type 1 and had a random high Blood sugar with no other documented symptoms.  This is why I advise to code only the type 1 with no complications, because the provider did not document a complication.


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## cathya35 (Dec 7, 2015)

*Coding Clinic for diabetes with hyperglycemia*

I had training for work in the past couple days and learned that there is a coding clinic article for coding diabetes with hyperglycemia in ICD-10 (Q3, 2013). 
Check out this link:
http://www.libmaneducation.com/coding-clinic-advice-diabetic-mellitus-hyperglycemia-q3-2013/


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