Home Health ICD-9/ICD-10 Alert

Question: My patient has diabetes with renal failure and is on dialysis, and has diabetic cataracts and polyneuropathy. How do I code all these manifestations?

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

• 250.4x (Diabetes with renal manifestations) and 585 (Chronic renal failure)

• 250.5x (Diabetes with ophthalmic manifestations) and 366.41 (Diabetic cataract)

• 250.6x (Diabetes with neurological manifestations) and 357.2 (Polyneuropathy in diabetes)

Tip: If the patient is on insulin, add V58.67 following the manifestation codes. And place the manifestation codes in order of their importance as the focus of care for this episode.

The medical record must show that the renal failure is due to diabetes, cautions Boyle. Otherwise code 585 (Chronic renal failure).

Trap: Don't be tempted to code for dialysis services. Dialysis is not covered under the home health benefit. Once a patient starts dialysis, they are covered under the ESRD program.