Coding Corner: Overcome 5th-Digit DM Obstacles With These Rules of Thumb

Pathology, complications, and control unlock diagnosis answers

As research continues to reveal new information about the nature and treatment of diabetes mellitus (DM), the information you need to code it correctly changes, too. Use these expert-supplied tips to keep abreast of the clinical details, and ensure your 250.xx code assignments are on target.

Keep Patient’s Type Consistent
The type of diabetes the patient has will often determine the fifth digit of the diagnosis code 250.xx. For patients with type I diabetes, you’ll report a fifth digit of either “1” (Type I, not stated as uncontrolled) or “3” (Type I, uncontrolled). For type II patients, the fifth digit will be either “0” (Type II or unspecified type, not stated as uncontrolled) or “2” (Type II or unspecified type, uncontrolled). Once you figure out the patient’s type, you’ll need to know whether the condition is controlled or uncontrolled to choose the appropriate fifth digit.
These tips should help you choose the correct type--and therefore the correct code:
Tip: Some things do stay the same.
Once a patient has diabetes, he won’t usually change types, says Garry Huff, MD, CCS, associate director of DRG Review Inc., who presented on diabetes coding at a recent American Health Information Management Association (AHIMA) meeting. “Once a type I, always a type I, once a type II, always a type II” is a helpful rule of thumb, he says. There are exceptions, but they aren’t common--so if you see that a patient has a history of type I diabetes, you’re safe reporting a fifth digit of 1 or 3, depending on whether the pa-tient’s condition is under control.
Tip: DKA is often a type I giveaway.
One major difference between type I and type II diabetes is that type I patients may be completely stable and then go into diabetic ketoacidosis (DKA) with little to no warning. On the other hand, type II patients are more variable on a regular basis. “DKA is more of a type I complication,” Huff says. “Type I patients have no insulin, and type II’s do, so type I’s are more prone to DKA.”
Mark the spot: If you see “positive serum acetone” in the documentation, it usually indicates DKA, Huff says--and therefore, a type I patient. But if the physician writes “positive serum acetone” without specifically stating DKA, you should query him before assuming the patient is type I.
Tip: Insulin dependence no longer indicates type.
Find a new way: If you’ve been using insulin dependence to determine that fifth digit, you’ve been out of luck this year. Since the code descriptors for diabetes changed for 2005, a patient’s status as insulin-dependent [...]

- Published on 2005-09-21