Question: Our practice struggles with reporting diabetic manifestations. When should we report a general diabetes code and when should we report a patient's specific manifestation with the appropriate fourth digit? And what if the patient has multiple manifestations?
Mississippi Subscriber
Answer: The bottom line is you should always report the most specific diabetes code possible. If your endocrinologist sees a diabetic patient for a simple routine check-up, but the patient has renal manifestations, you should report 250.4x, not 250.0x. Even if the physician doesn't specifically treat the patient's renal problems during the visit, the most specific code to describe the patient is still 250.4x.
The more the merrier: You can actually report multiple manifestations by listing multiple 250.xx codes with the appropriate fourth digits. For example, if a type II, uncontrolled diabetic patient has three chronic manifestations - ophthalmic, neurological and circulatory - you can list 250.52, 250.62 and 250.72, along with the additional corresponding manifestation codes, such as 366.41 (Diabetic cataract) and 337.1 (Peripheral autonomic neuropathy).
Additional manifestation codes help paint a more detailed picture of the patient's complicated condition, and are particularly necessary for inpatients because the endocrinologist is probably dealing with all the patient's manifestations. However, you don't always need to list multiple manifestations in the outpatient setting. If a diabetic patient with several manifestations presents for an office visit, you can usually just list the manifestation the endocrinologist treats that day. If he treats more than one manifestation, you may want to only report the code for the most prominent or advanced manifestation.
250.xx is always primary: Remember always to report the specific diabetes code first, and then the corresponding chronic manifestation code as the secondary diagnosis.
- The answers to the Reader Questions and You Be the Coder were provided and/or reviewed by Joan Logue, BS, MT-ASCP, principal with Health Systems Concepts Inc. in Longwood, Fla.; William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.; Elaine Rehmer, CPC, administrator at Cosmopolitan Diabetes Center in Columbia, Mo.; Alison Nicklas, RHIT, CCS, director of education and training for Precyse Solutions, based in King of Prussia, Pa.; Judy Richardson, MSA, RN, CCS-P, senior consultant, Hill & Associates in Wilmington, N.C.; and Anthony Azzi, MD, clinical endocrinologist with Raleigh Endocrine Associates, Raleigh, N.C.
