# Coding Diabetes-Physician sees a diabetic



## Debbie C

Good Afternoon Everyone!!

Physician sees a diabetic patient, codes 250.60 (diabetic peripheral neuropathy) and 2nd code is required to identify the manifestation.  However, 2nd code is not billed.

My question is, can 250.60 be used without the 2nd code or does it need to be downcoded to 250.00?

Seems if a 2nd code is required to identify a manifestation and it is not used, it would have to be coded just as 250.00.

*****I am looking at this from an internal audit standpoint, in case that matters****

Thank you SO much!   
Debbie


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## rthames052006

Debbie C said:


> Good Afternoon Everyone!!
> 
> Physician sees a diabetic patient, codes 250.60 (diabetic peripheral neuropathy) and 2nd code is required to identify the manifestation.  However, 2nd code is not billed.
> 
> My question is, can 250.60 be used without the 2nd code or does it need to be downcoded to 250.00?
> 
> Seems if a 2nd code is required to identify a manifestation and it is not used, it would have to be coded just as 250.00.
> 
> *****I am looking at this from an internal audit standpoint, in case that matters****
> 
> Thank you SO much!
> Debbie




My first instinct would be to querry the physican.  In order to "code this correctly" you do need the 2nd code, if it's not within the documentation the physician could do an ammendment to the note.


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## mitchellde

The documentation should support a manifestation code if they coded the 250.60, or perhaps it was miscoded?  If the claim has already processed then it is too late for an amendment to the note.


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## Debbie C

rthames052006 said:


> My first instinct would be to querry the physican.  In order to "code this correctly" you do need the 2nd code, if it's not within the documentation the physician could do an ammendment to the note.



Thank you for your response.  Since I am auditing the records sometimes months after the visiti, the claim has been processed etc.  I am wanting to educate the physician as to whether or not the 250.60 would be down coded to 250.00 without the 2nd ICD9 code.  Basically, can a 250.60 be used without the 2nd code?  

Thanks again!!!


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## mitchellde

no it must have the manifestation listed as well


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## adebisihamilton

I believe the manifestion is already given as "peripheral neuropathy."  So you can go ahead and code 250.60 and 357.2.


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## acanny1

*Diabetes with Neurological Manisfestation*

250.60 has many secondary manifestation and they need to be documented on the medical records according the the ICD-9 documentation guidelines. Many manifestation includes :
358.1
337.1
607.84
713.5
357.2
707.9

Always remember the golden rule if is not documented it never happen!


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## grothrock

If they do not address the maifestation specifically can you go back to 250.00?  I was under the impression once the 250.60 (peripheral neuropathy) process happens it doesn't go away or resolve. My providers state 250.60 is a current condition but 357.2 was not discussed specifically. ICD-9 guidelines Section IV .6 says code all documented conditions that coexist at the time of the encounter and require or affect pt care, treatment or management. It accuratly represents pt's diabetic status; I have asked this question before but have never gotten an answer.


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## hannahgasser

Diagnosis codes are unfortunately used for two different purposes. The CDC/WHO keeps track of them for statistical and disease tracking purposes. In this case, when the peripheral neuropathy is documented as a manifestation of the diabetes, it would be appropriate (Per ICD-9-CM Guidelines) to assign the etiology/manifestation code. Diagnosis codes should always be assigned to the highest degree of specificity supported by the documentation.

For Payers ICD-9 codes establish medical necessity. If the provider only saw the patient for 250.00 and did not address the neuropathy (Rx mangement, referral, assesment of condition) or document in the assessment/plan how it affected the MDM I would not count the peripheral neuropathy diagnosis when determining the level of service for E/M auditing purposes.

In this case, when providing physician education, I would not take the approach that the diagnosis needed to be "downcoded" but that there needed to be additional information documented in order to correctly assign the diabetes and required manifestation code (the "Etiology/manifestion convention" always requires both codes, ICD-9-CM Official Guidelines, Section I., B., 6.)


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