Coding 101: Diabetes Diagnosis

Reporting a diabetes diagnosis requires definitive coding to reflect the complicated status of the patient. You'll need to report the most specific diabetes diagnosis code possible if you want full payment for all of your physician's E/M services. Follow these easy steps to success:

1. Start with 250.xx (Diabetes mellitus).

2. Select the fourth digit by determining what, if any, complications the patient has. If the patient has more than one complication, as is often the case, code only for the complications addressed at a particular visit. You should also use additional codes to identify the actual manifestations of the complications, if possible (e.g., 365.44, Glaucoma associated with systemic syndromes). 

Fourth-digit choices for 250.xx:


250.0 - Diabetes mellitus without mention of complication

250.1 - Diabetes with ketoacidosis

250.2 - Diabetes with hyperosmolarity

250.3 - Diabetes with other coma

250.4 - Diabetes with renal manifestations

250.5 - Diabetes with ophthalmic manifestations

250.6 - Diabetes with neurological manifestations

250.7 - Diabetes with peripheral circulatory disorders

250.8 - Diabetes with other specified manifestations (e.g., hypoglycemic shock)

250.9 - Diabetes with unspecified complication.

3. Choose the fifth digit based on whether the patient is Type I or Type II and is controlled or uncontrolled. This is a determination that only the physician can make, so consult the medical chart documentation.

Fifth-digit choices for the 250.xx series:

0 - Type II (non-insulin dependent type) or unspecified type, not stated as uncontrolled

1 - Type I (insulin dependent type), not stated as uncontrolled

2 - Type II (non-insulin dependent type) or unspecified type, uncontrolled

3 - Type I (insulin dependent type), uncontrolled.

4. Report the diabetes code first and the complication manifestation code second when dealing with a patient who has diabetes complications. For example, for a patient with Type I diabetes with glaucoma complications, you report 250.51 (Diabetes with ophthalmic manifestations ...) listed first, with the manifestation code for glaucoma, 365.44, listed second.

- Published on 2004-02-10