Answers to the Diabetes Coding Quiz

1. c. V45.85 (Insulin pump status)
 
Once you're past the initial set-up stages, this V code is what you'll use for all follow-up visits as long as the patient has the insulin pump.
 2. a. 1

Code 250.1 indicates diabetes with ketoacidosis. Don't forget to add the appropriate fifth digit as well to indicate the patient's diabetes type and status.
 3. b. 0

According to ICD-9, a fifth digit of "0" indicates a "type II [non-insulin dependent type] or unspecified type, not stated as uncontrolled."
4. a. 250.51 first, 365.44 second

Always report the diabetes code as the primary diagnosis and the complication code as the secondary diagnosis. So in this case, 250.51 (Diabetes with ophthalmic manifestations ...) is primary and 365.44 (Glaucoma associated with systemic syndromes) is secondary.
5. c. List them all.

Contrary to what some coders believe, you can list multiple 250.xx codes with the appropriate fourth digits to indicate multiple complications. For outpatient settings, you won't always need to list all of the patient's chronic manifestations -- just those that the physician treats during the visit.

If a patient is in the hospital, however, the physician is most likely treating all of the patient's manifestations to some degree. Remember, in addition to these primary diagnosis codes, you also need to list the corresponding manifestation codes, such as 366.41 (Diabetic cataract), as secondary diagnoses.
6. b. 648.0

If a pregnant woman's established diabetes diagnosis is now complicating her pregnancy, you should report 648.0x (Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth or the puerperium; diabetes mellitus) and then 250.xx.

Assign the fourth digit to the 250.xx code based on whether the physician documented any complications. Don't be tempted to use code 648.8, because this describes gestational diabetes, which affects pregnant women who have had no prior history of diabetes.

- Published on 2004-05-20