Home Health ICD-9/ICD-10 Alert

Answer: There is a new kind of diabetes called Type 3 or Type 1½. The phenomenon is also known as "double diabetes" or "hybrid diabetes," and it's harder to diagnose and significantly more difficult to treat, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, Texas.

The person has Type 1 diabetes treated with insulin but also has insulin resistance. Research has shown that Alzheimer's may even be Type 3. Many of the unexplained features of Alzheimer's, such as cell death and tangles in the brain, appear to be linked to abnormalities in insulin signaling. This demonstrates that the disease is most likely a neuroendocrine disorder, or another type of diabetes.

There currently is no specific code for Type 3. Code the diabetes as unspecified with a fifth digit of "0." Also add the code V58.67 (Long-term [current] use of insulin) if the patient is expected to be on insulin long-term.

You should always query the physician when "insulin dependent diabetes" is documented because the term is outdated, and its true meaning is juvenile type diabetes. With such a statement from the physician, you may consider asking whether the diabetes was induced by another condition or event, such as steroid induced diabetes, because there is no Type 1 or Type 2 in steroid induced diabetes, now coded with a 249.x (Secondary diabetes mellitus) category code.