Nail Down the Appropriate Diabetes Dx Every Time

Report only diabetic complications related to current episode of care
Patients with diabetes often have one or multiple complications that require the physician’s extra attention and consideration -- and which your coding should therefore reflect.
Use these four steps for definitive diabetes diagnosis coding to ensure that your ICD-9 codes justify the services you bill.

1. Select Fourth Digit First

You must determine the fourth digit for 250.xx (Diabetes mellitus) according to the type of diabetic complication the patient has, if any. Diabetes patients may have more than one complication. If this is the case, you should code only the complication relevant to services your physician renders that day.

2. Identify Type for Fifth Digit

The fifth digit provides the final two pieces of information on the patient’s diabetic condition: the diabetes type (I or II) and whether it is controlled.
To select the proper fifth digit, you must first know what the following ICD-9 descriptor terms mean:
Type I: The patient’s pancreatic beta cells no longer produce insulin. People with type I diabetes must take insulin. ICD-9 descriptors also refer to type I as "juvenile type" diabetes.
Type II: The patient’s beta cells do not produce sufficient insulin, or the beta cells have developed insulin resistance. People with type II may not have to take insulin.
Not stated as uncontrolled: The patient’s diabetes is managed sufficiently by diet and/or insulin.
Uncontrolled: A patient can have uncontrolled diabetes when the physician documents that blood sugar levels are not acceptably stable, when the patient is not in compliance with his diabetes management plan, or if the patient is taking medications for another illness that interfere with diabetes management.

First, check the physician’s documentation to see what type of diabetes the patient has and whether the condition is controlled. Then choose one of the following fifth digits:
• 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.

Don’t worry when your list of frequently used diagnoses turns up lots of 250.00s. "Ninety percent of diabetes in the United States is type II," says Sheri Poe Bernard, CPC, CPC-H, CPC-P. "The default for documented diabetes would be 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled)," she said in her presentation "Understanding Diabetes" at a recent American Academy of Professional Coders’ conference.

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- Published on 2008-03-14