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ED Coding and Reimbursement Alert

Reader Questions :

Remember Primary Dx Code for These Diabetics

Published on Sun Feb 28, 2010

Question: I have a puzzling claim in front of me. The notes indicate that the nonphysician practitioner (NPP) provided a level-three E/M service for a patient with "2ndary diabetes w/renal manifest." Do I have enough information to choose a diagnosis code with these notes?Minnesota SubscriberAnswer: You've got enough there to choose 249.40 (Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified) for the patient's secondary diabetes.The 249.40 code reveals two elements: the patient has diabetes, and the diabetes is causing additional physiological issues (in your patient's case, renal manifestations). You need at least two elements to paint a complete diagnosis picture for these patients, however. In the descriptor below 249.40, it says "Use additional code to identify manifestation."So let's say that the patient is suffering from Kimmelstiel-Wilson syndrome. On the claim, you'd report the following:99283 (Emergency department visit for the evaluation and management of a patient, which [...]
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