CODING CORNER: Nail Diabetes Coding Every Time in 3 Simple Steps

Tip: When diabetes type isn’t specified, report type II
Are you providing crucial details when reporting diagnosis codes for your diabetic patients? If you’re not using the right fourth and fifth digits for 250.xx, you’re not giving sufficient specifics, according to ICD-9 coding guidelines.

Fact: 20.8 million Americans have diabetes, according to the national diabetes fact sheet created by the Centers for Disease Control and Prevention, the National Institutes of Health, and the American Diabetes Association. And the incidence of diabetes in the United States has risen sixfold over the past 50 years, says Sheri Poe Bernard, CPC, CPC-H, CPC-P, clinical staff member at Ingenix in Reston, Va.

The big three: To make sure you’re coding diabetes correctly, you’ll need to know three pieces of information: which type of diabetes your patient has, whether the diabetes is uncontrolled, and whether your patient is suffering from any manifestations of diabetes.

1. Determine whether the  diabetes is type I or type II.
Type I diabetes, also known as juvenile-type, is the result of autoimmune destruction of the pancreatic beta cells, which causes insulin production to cease, says Deborah J. Grider, CPC, CPC-H, CPC-P, CCS-P, EMS, president of Medical Professionals Inc. in Indianapolis.

Type II diabetes, also called adult-onset diabetes, is caused by the body’s inability to respond to insulin that is produced, Grider says.

Ninety percent of diabetes in the United States is type II, Bernard says.

Follow the rule: If the type of diabetes is unspecified, ICD-9 coding conventions require you to report a type II code if you are unable to get details from the clinician who documented the diabetes.

The terms “insulin-dependent diabetes” (IDDM) for type I and “non-insulin dependent diabetes” (NIDDM) for type II were removed from ICD-9 code descriptions in 2005, Grider says. While NIDDM is generally type II, it doesn’t follow that all patients documented as IDDM are type I, Bernard says. Some type II diabetics require insulin for good control, she says.

And speaking of control, that’s one more piece of information you’ll need before you can select your fifth digit.

2. Pinpoint whether the diabetes is uncontrolled.
To code for uncontrolled diabetes, you must have physician documentation stating that the diabetes is uncontrolled. Don’t assume you can select an uncontrolled code based on a high blood glucose reading or if the physician says the diabetes is “poorly controlled,” Bernard says.

When you know which type of diabetes your patient has and whether it’s uncontrolled, you can select your fifth digit from the following options:

• 0 -- type II or unspecified type, not stated as uncontrolled

• 1 -- type I (juvenile type), not stated as uncontrolled

• 2 -- type II or unspecified type, uncontrolled

• 3 -- type I (juvenile type), uncontrolled.

Additional code: When [...]

- Published on 2006-11-09