# Diabetes with Manifestations coding



## jsrumples (Dec 27, 2010)

Hi, 
We have a Provider who while examining a patient only discussed or reviewed the Diabetes during an office visit. The patient has Diabetes with a manifestation but he did not address nor reference the manifestation in his notes. He coded the encounter with a 250.40 diabetes II renal manifestations. 
The coders came back to him asking him to update his note to reference the manifestation as in renal manifestation is being handled by Doctor such and such and to add the renal manifation ICD9 code to the enounter. 

The Provider is refusing to since he did not mention or deal with the renal manifestation. 

Question is we cant leave the 250.40 ICD9 code on this encounter as it is incomplete without the mention of the manifestation as well as coding of the manifestation but can we actually change it back to a 250.0X code since the patient is already diagnosed with the manifestation diabetes code in prior encounters?? 

Not sure what to do in this situation so any help would be greatly appreciated!!! Thanks, Jenn


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## mitchellde (Dec 27, 2010)

Each encounter has to stand on its own from the documetation so without mention of the complication of the renal issue then you have no choice but to change the code to match.  So I would chose the 250.0x.


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## Sanjith (Dec 28, 2010)

*Diabetes with renal manifestation*

Hi 
   Some of our physician documents condition as diabetes with renal manifestation and does not specify what the manifestation is. Our coders, code this condition with only 250.40, is this correct, please give your suggestion on this.

Sanjeeth kumar, CPC


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## Nanny7792 (Dec 28, 2010)

*Diabetes with renal manifestation*

Hi,
When coding Diabetes with a manifestation you should add the manisfestation. Here are some examples for renal.
250.40    Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled  
        Use additional code, to identify manifestation, as:  
        chronic kidney disease  (585.1-585.9)  
        diabetic:  
        neropathy  (583.81) 
        nephrosis  (581.81)  
        intercapillary glomerulosclerosis  (581.81)  
        Kimmelstiel-Wilson syndrome  (581.81)  
        Use additional code, if applicable for associated long-term (current) insulin use  (V58.67)  

KSS,CPC, Audit Specialist


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## mitchellde (Dec 28, 2010)

Sanjith said:


> Hi
> Some of our physician documents condition as diabetes with renal manifestation and does not specify what the manifestation is. Our coders, code this condition with only 250.40, is this correct, please give your suggestion on this.
> 
> Sanjeeth kumar, CPC



You cannot code 250.40 without the manifestation code.  If the manifestation is not documented then there is none.  Does the physician really state in the actual note that the patient has renal manifestations of their diabetes and not say anything more?  If this is the case then the coders will need to send the documentation back for clarification.


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## Sanjith (Dec 28, 2010)

Thanks for the reply; Our physician have documented just diabetes with renal manifestation and not the renal problem. is it appropriate to give unspecified renal complication code as additional to 250.40 in this case?


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## Sanjith (Jan 5, 2011)

*Diabetic renal manifestation*

Is the term Diabetic renal manifestation similar to the term diabetic nephropathy? if so, when physician documents only the term Diabetic renal manifestation, no more specification on renal manifestation,  can we code 250.40 and 583.81 for this. Please anyone clarify this. Thanks:


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## Grintwig (Jan 5, 2011)

In my opinion no. If the physician does not specify the manifestation then it is the 250.0x code only. At least as far as I am concerned. And if the physician does not address the specific complication in his notes then he didn't treat it at least according to documentation rules.


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## mjb5019 (Jan 27, 2012)

*diabetes without the manifestation listed*

My question regards how the coding will hold up to the documentation during an audit.  There is no guideline that states that if the manifestation isn't known, code 250.XX, so, during an audit, wouldn't we be able to defend the use of the diabetic condition code without the manifestation with that specific note as the document?  How can we defend the use of 250.0X without a guideline specifically guiding us there in abscence of a stated manifestation?


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## mitchellde (Jan 27, 2012)

You cannot use the 250 code indicating a manifestion and then not code the manifestation, the codes state in the code book to "use an additional code to code the manifestation as:" xxxxxxx
 this notation does not state: "if the coder wants to"  .  You still need to query the provider to be more specific in the documentation.


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## dadhich.girish (Jan 30, 2012)

250.0x w/o manifestation - that's how we have always coded it.


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## mjb5019 (Jan 31, 2012)

*DM manifestation*

I agree that query the provider is the correct step.  If however, the provider no longer belongs to the group and is unavailable to answer query, I maintain the coding guidelines do not direct you back to the 250.00, and may not hold up in an audit.  Just sayin'. Ponderable point.


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## Pbing2016 (Aug 2, 2012)

*Diabetes coding w/o the mainisfestation*

I am struggling with one of my providers as well with this issue. The provider wants me to just code the 250.40, and not the manifestation. The provider will not take the time to listen and understand that I cannot report the 250.40 as a stand alone code. The provider has clearly documented the manifestation. How do I approach this so that he/she understands that this will not be accepted?


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