Type I and Type II Review: Insulin Dependence Is No More - Starting Now

Remember to implement ICD-9 coding changes this month
You've got no time to lose if you haven't already learned the new diabetes fifth-digit descriptors and the rules for assigning each one appropriately.

The 2005 ICD-9-CM manual offers revised fifth-digit descriptors for 250.xx (Diabetes mellitus) to help you assign type I and type II more easily. The new fifth digits are as follows:

0 - Type II or unspecified type, not stated as uncontrolled

1 - Type I [juvenile type], not stated as uncontrolled

2 - Type II or unspecified type, uncontrolled

3 - Type I [juvenile type], uncontrolled.
Note 2 Main Descriptor Omissions
1. Adult onset. The revised code descriptors for type II diabetes (fifth digits "0" and "2") no longer include "adult-onset type" because children can also develop type II diabetes. The "adult-onset type" designation confused physicians and coders in the past by making them think the patient must be an adult in order to assign a fifth digit of "0" or "2."

2. Insulin dependence. The revised code descriptors omit the "[insulin dependent type] [IDDM]" designation from type I fifth digits "1" and "3." The descriptors also omit "[non-insulin dependent type] [NIDDM type]" from type II fifth digits "0" and "2." In the past, the insulin designations had led physicians and coders to incorrectly assign type I diabetes to any patient taking insulin, even though many type II patients use insulin also.

Beta cell function: Endocrinologists and coders should now be sure to assign type I diabetes (250.x1 or 250.x3) to patients whose pancreatic beta cells do not produce insulin, says Anthony Azzi, MD, clinical endocrinologist with Raleigh Endocrine Associates in Raleigh, N.C. Type I diabetics must use insulin.

Assign type II diabetes (250.x0 or 250.x2) when the patient's pancreatic beta cells do not function properly and have insulin resistance, but still produce some insulin, Azzi says. Type II diabetics may also use insulin, depending on the disease's severity.

New addition: Below the descriptors for fifth digits "0" and "2" for type II diabetes, you will now see the following:

"Fifth-digit [0, 2] is for use for type II patients, even if the patient requires insulin. Use additional code, if applicable, for associated long-term (current) insulin use - V58.67."

Experts recommend that you should report the new V code (V58.67, Long-term [current] use of insulin) as a secondary diagnosis for any diabetic patient now using insulin. CMS has not yet defined the phrase "long-term," so you don't need to consider that when assigning this code.
Don't Forget Other New ICD-9 Codes
The 2005 ICD-9-CM also lists these new codes:

252.00 - Hyperparathyroidism, unspecified

252.01 - Primary hyperparathyroidism

252.02 - Secondary hyperparathyroidism, non-renal

252.08 - Other hyperparathyroidism.
These codes will allow you [...]

- Published on 2004-10-19