New Edition of ICD-9 Gives Your Diabetes Codes a New Look

Omission of insulin and non-insulin dependence may simplify your choice
Starting Oct. 1, you and your endocrinologist may find it easier to assign diabetes ICD-9 codes (250-250.9) now that insulin dependence will play a lesser role in the definitions of type I and type II diabetes.
CMS recently announced new and revised ICD-9 codes for 2004-2005. When the changes take effect on Oct. 1, your endocrinologist should determine how well the patient's pancreatic beta cells function to distinguish between the diabetes codes'fifth digits, says Beth Fisher, medical systems specialist with the National Center for Health Statistics (NCHS) in Hyattsville, Md. The NCHS and CMS oversee all ICD-9 changes.
Know the Definition of Each Diabetes Type
Now, endocrinologists use insulin and non-insulin designations to determine whether patients have type I or type II diabetes. As a coder, you then assign a fifth digit to the appropriate 250.xx (Diabetes mellitus) code to indicate the patient's diabetes type.
But the problem with the current system is that physicians often assign a type I diabetes diagnosis to any patient who takes insulin, even though many type II patients use insulin also, says Deborah Arneson, CPC, coding supervisor at Kernodle Clinic in Burlington, N.C. That's why the code descriptors'deleted insulin designation is a good change that should alleviate a lot of confusion for physicians and coders, she says.
Type I diabetes is relatively rare compared to type II. "Statistics demonstrate that only 5 to 10 percent of all diabetics have type I diabetes," which is an autoimmune disorder, says Alison Nicklas, BS, RHIT, CCS, director of education and training for Precyse Solutions, based in King of Prussia, Pa. The tendency of coders and physicians to inaccurately over-report type I diabetes diagnoses based on insulin dependence is therefore wrong both on an individual patient basis and in terms of the overall diabetic population, she adds.
Define diabetes based on beta cell function: As of Oct. 1, endocrinologists should separate the two types of diabetes and choose the fifth digits using two methods:

Type I -- The physician should assign 250.x1 or 250.x3 when the patient's pancreatic beta cells no longer produce insulin. Patients with type I diabetes must use insulin.


Type II -- Your doctor should use 250.x0 or 250.x2 when the patient's pancreatic beta calls do not function properly and have insulin resistance. Also, type II patients may use insulin, depending on the severity of their condition. Pregnant patients with gestational diabetes (648.8x) often take insulin to maintain proper blood sugar levels.

ICD-9 Changes Start Earlier This Year
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- Published on 2004-06-21