# diabetes



## JulesofColorado (Jul 15, 2009)

It is coded as 250.00 & V58.67.


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## dballard2004 (Jul 15, 2009)

To quote the ICD-9 guidelines,...."if the documentation does not indicate the type of diabetes, but does indicate that the patient uses insulin, the appropriate fifth digit for type II must be used."  Hope this helps.

SOURCE: ICD-9-CM Official Guidelines for Coding and Reporting, page 27


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## FTessaBartels (Jul 15, 2009)

*Insulin DEPENDENT = Type 1*

Insulin *DEPENDENT* is the same as Type 1 or Juvenile diabetes ... i.e. the patient MUST use insulin.

F Tessa Bartels, CPC, CEMC


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## JulesofColorado (Jul 15, 2009)

The use of insulin does not mean that a patient is a Type I diabetic. 

"Some patients with type II diabetes mellitus are unable to control their blood sugar through diet and oral medication alone and do require insulin. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, the appropriate fifth-digit for type II must be used. For type II patients who routinely use insulin, code V58.67, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code V58.67 should not be assigned if insulin is given temporarily to bring a type II patient's blood sugar under control during an encounter."


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## cheermom68 (Jul 15, 2009)

I totally agree with Jules.  Type II can be insulin dependent.  Insulin dependent does not necessary mean Type I unless indicated by the physician as such.


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## mitchellde (Jul 15, 2009)

That is correct Insulin dependent does not automatically make the patient a type I.  the difference between a type I and Type II patient has to do with pancreatic beta cells.  When pancreatic beta cells do not exist or function the patient is a type I.  For a patient classified as type II the pancreatic beta do function but it is possible the patient is resistent to the insulin being secreted or the cells are not producing enough which could then make the patient insulin dependent.   So the guidelines do tell us to default to type II when the physician fails to document the type.


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## JulesofColorado (Jul 16, 2009)

When the type of diabetes is not documented but does indicate that the patient uses insulin, the default is type 2. The fact that a patient is receiving insulin does not indicate that the diabetes is type 1.


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## FTessaBartels (Jul 16, 2009)

*Definition*

From Stedman's Medical Dictionary for the Health Professions and Nursing, Illustrated, Fifth Edition:
*Insulin dependent diabetes mellitus *(IDDM): Severe diabetes mellitus, often brittle, usually of abrupt onset during the first two decades of life but can develop at any age; characterized by polydipsia, polyuria, increased appetite, weight loss, low plasma insulin levels, and episodic ketoacidosis; immune-mediated destruction of pancreatic B cells; insulin therapy and dietary regulation are necessary. SYN growth-onset diabetes, juvenile-onset diabetes, Type I diabetes. (emphasis added by FTB)

Insulin dependent = Type 1 diabetes.  Insulin DEPENDENCE is *NOT* just use of insulin.

F Tessa Bartels, CPC, CEMC


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## JulesofColorado (Jul 16, 2009)

If the type of diabetes mellitus is not documented in the medical record the default is type II. 
IDDM is coded as 250.00 and V58.67


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## LLovett (Jul 16, 2009)

I agree with Tessa that IDDM is type I.

Insulin dependent indicates they are type I, a type II that takes insulin is referred to as insulin requiring. There is a difference. Dependent means they will die without it.

The problem is many people, doctors included, do not use the terminology correctly. So for coding purposes we have to default to type II if all they state is IDDM. I don't agree with it, and I don't like it, but it is what it is.

Just my 2cents,

Laura, CPC


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## mitchellde (Jul 19, 2009)

The CDC removed from the definition of type I diabetes the term IDDM, it is not synonomous with type I.  It was back in the day but no longer.  This was changed in 2004 and it was either 1st quarter of 04 or 05 where coding clinics put out a clinic with just a ton of information on on diabetes and the physiology and why the definition has changed.  But it does have to do with the issue of dependence based on the body's ability or inability to produce insulin to a degree.  While one persons need for insulin may be due to type II diabetes their need is no less a dependence than a type I in some cases for without the insulin in both cases the patient will expire.  So the issue is not for use to determine if one persons use is anothers dependence, however the guidelines are specific in that age nor insuline dependence shall determine for the coder the diabetes type.


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## nilewis (Apr 11, 2014)

I have a provider that is telling me that her type 2 diabetic patients are converting into type 1 and therefore the chart shows both types of diabetes in it for the patient.  When I asked her about this she said that the insulin pumps will not get paid for with out the type 1 diagnosis for the patients.  Please advise on the correct coding


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## mitchellde (Apr 11, 2014)

Type 2 diabetes cannot progress or convert to type 1.  I ran into this with a provider a few years ago and his rationale was he understood that when a type 2 patient became insulin dependent then they had converted or progressed to a type 1.  This is absolutely not true, and I had to go to several medical textbooks and physiology definitions before I convince him that this is in fact incorrect.  Is this the reason your provider is saying this? You cannot change a patient's diabetes type just to make certain services pay.  However you can indicate type 2 with insulin dependence by appending the V58.67


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