ED Coding and Reimbursement Alert

 Pathology, complications, and control unlock diagnoses As research continues to reveal new information about the nature and treatment of diabetes mellitus (DM), the information you need to code it correctly changes, too. Use these expert-supplied tips to keep abreast of the clinical details and ensure your 250.xx code assignments are on target. Take These Type Hints The type of diabetes the patient has will often determine the fifth digit of the diagnosis code 250.xx. For patients with type I diabetes, you'll report a fifth digit of  1 (Type I [juvenile type], not stated as uncontrolled) or 3 (Type I [juvenile type], uncontrolled).
 
For type II patients, the fifth digit with be 0 (Type II or unspecified type, not stated as uncontrolled) or 2 (Type II or unspecified type, uncontrolled). Once you figure out the patient's type, you'll need to know whether the condition is controlled or uncontrolled to choose the appropriate fifth digit.
 
These tips should help you choose the correct type - and therefore the correct code:
 
Tip: Some things do stay the same. Once a patient has diabetes, he doesn't usually change types, says Garry Huff, MD, CCS, associate director of DRG Review Inc., who presented on diabetes coding at a recent American Health Information Management Association (AHIMA) meeting. "Once a type I, always a type I, once a type II, always a type II" is a helpful rule of thumb, he says. There are exceptions, but they aren't common - so if you see that a patient has a history of type I diabetes, you're safe reporting a fifth digit of "1" or "3," depending on whether the patient's condition is under control.
 
Tip: DKA is often a type I giveaway. One major difference between type I and type II diabetes is that type I patients may be completely stable and then go into diabetic ketoacidosis (DKA) with little to no warning. Type II patients, on the other hand, are more variable on a regular basis. "DKA is more of a type I complication," Huff says. "Type I patients have no insulin, and type IIs do, so type I patients are more prone to DKA."
 
Mark the spot: If you see "positive serum acetone" in the documentation, it usually indicates DKA, Huff says - and therefore, a type I patient. But if the physician writes that without specifically stating DKA, you should ask him before assuming the patient is type I.
 
Tip: Insulin dependence no longer indicates type.

Find a new way: If you've been using insulin dependence to determine that fifth digit, you've been out of luck this year. Since the code descriptors for diabetes changed for 2005, a patient's status as insulin-dependent or non-insulin-dependent is not a determining factor in [...]