ED Coding and Reimbursement Alert

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 Subscriber

Answer: 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 requires these 3 key components: a expanded problem focused history; an expanded problem focused examination; and moderate medical decision making ...) for the E/M
• 249.40 (Secondary diabetes mellitus with renal manifestations, not stated as uncontrolled, or unspecified) appended to 99283 to represent the patient's diabetes, followed by
• 581.81 (Nephrotic syndrome; with other specified pathological lesion in kidney; nephrotic syndrome in diseases classified elsewhere) appended to 99283 to represent the patient's renal manifestation.

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky,MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.