Home Health ICD-9/ICD-10 Alert

Question: We have a patient who has been experiencing vertigo and confusion. Home health has been ordered to monitor the patient for transient ischemic attacks (TIA) and medication compliance. The patient has a history of diabetes with chronic kidney disease (CKD), Stage IV; anemia related to the CKD; diabetes with retinopathy; and diabetes with polyneuropathy. How should we code for this patient?


North Carolina Subscriber


Answer: Code for this scenario as follows, suggests Laresa Boyle, RHIA, director of coding services at Longview, TX-based Healthcarefirst:

M0230: 780.4 (Vertigo, NOS);
M0240b: 298.9 (Unspecified psychosis);
M0240c: 250.40 (Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled);
M0240d: 585.4 (Chronic kidney disease, Stage IV [severe]);
M0240e: 250.50 (Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled);
M0240f: 362.01 (Diabetic retinopathy);

Other pertinent diagnoses: 250.60 (Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled) and 357.2 (Polyneuropathy in diabetes). 

In this episode, the main focus of home health is the vertigo and the confusion because these are symptoms of TIA. You can't actually code TIA because the patient hasn't been diagnosed with it.

Watch for: When you have diabetes with multiple manifestations, you must code each one separately; thus you have a long list of diabetes diagnoses.