Diabetes Complications Got You Confused?

5 tips help your diabetes diagnosis codes justify higher-level E/M services

Reporting the details of a diabetic patient's condition gets tricky when you must select the proper fourth digit for 250.xx plus the corresponding complication codes, but our experts will show you how.
 
You can list them all: Your practice's diabetic patients can have one or multiple diabetic complications and chronic manifestations. But what some endocrinology coders don't realize is that you can report multiple complications by listing multiple 250.xx codes with the appropriate fourth digits, says Alison Nicklas, RHIT, CCS, director of education and training for Precyse Solutions, based in King of Prussia, Pa. Listing all of a patient's complications will paint a more complete picture for your payer and help to justify higher-level E/M services.
 
For example, if a Type II, uncontrolled diabetic patient has four chronic manifestations - renal, ophthalmic, neurological and circulatory - you can actually list 250.42, 250.52, 250.62 and 250.72, along with the corresponding manifestation codes, such as 581.81 (Nephrotic syndrome) and 366.41 (Diabetic cataract).
 
In outpatient settings, you won't always need to list all the patient's chronic manifestations. It should suffice to list just the manifestations the endocrinologist treats on a given visit. For inpatients, however, it's likely the physician is dealing with all the patient's manifestations. In this case you would list all the appropriate codes, says Elaine Rehmer, CPC, an administrator at Cosmopolitan Diabetes Center in Columbia, Mo.
 
250.xx is primary: Always code first the diabetes and report the chronic manifestation code as the secondary diagnosis, says Anita Carr, CPC, business office manager and assistant practice manager for Endocrine and Diabetes Associates in Louisville, Ky.
 
Remember this: The physician must clearly identify a patient's complication or chronic manifestation as being caused by the diabetes. The code descriptors in the ICD-9 manual can be confusing because they use the word "with" (i.e., Diabetes with renal manifestations), leading some coders to assume there doesn't need to be a causal connection between the complication and the diabetes, Nicklas says. Be careful not to assume anything. The documentation must define a condition as a diabetic complication or manifestation for it to be coded as such, she adds.

5 Tips Help You Beat Tricky Complications
Each time you choose a fourth digit for 250.xx, you  also need to select the appropriate code to identify the specific diabetic manifestation. While the ICD-9 manual lists several possible manifestation code choices below each fourth-digit descriptor, it's important to realize that this is "definitely not an exhaustive list," Nicklas says. For example, 583.81 (Nephropathy) and 581.81 (Nephrosis) are listed as possible manifestation codes below 250.4x (Diabetes with renal manifestations), but 585 (Chronic renal failure) is not listed and is also a possible renal [...]

- Published on 2004-04-16