Home Health ICD-9/ICD-10 Alert

Question: Our 68 year old female patient is a newly diagnosed diabetic and has been placed on insulin at home. She also suffers from chronic Schizophrenia. Home Health is ordered for diabetic teaching including insulin administration. How should we code for this patient?

— South Carolina Subscriber

Answer: Code for this patient as follows, says Andrea Manning, BS, RN, HCS-D, COS-C, of Manning Healthcare Group in Talkeetna, Alaska:

• M1020a: 250.00 (Diabetes mellitus without mention of complication, type 2 or unspecified type, not stated as uncontrolled)
• M1022b: 295.92 (Unspecified Schizophrenia, chronic); and
• M1022c: V58.67 (Long-term (current) use of insulin).

Report your patient’s diabetes with 250.00 in M1020 because it is the focus of care and the primary reason the patient is being admitted to home health skilled services, Manning says. The V code for the long term use of insulin (V58.67) does not need to immediately follow the diabetes code, so you can sequence this at the bottom of the list.

As with most mental disorders, Schizophrenia will always impact the plan of care and should be coded, in this case, as a secondary diagnosis, Manning says. This category requires 5 digits for a complete code. The physician has not specified the type of Schizophrenia your patient has, but has indicated that it is chronic. In Schizophrenia code 295.92, the fourth digit "9" indicates unspecified, and the fifth digit "2" indicates chronic.

Always pay very close attention when assigning codes for mental, behavioral and neurodevelopment disorders, Manning cautions. It’s important to check with the physician if you have any doubt as to which code is correct. In this case, the mental disorder is not the primary diagnosis, so you’ll list it as a secondary diagnosis, even if you won’t be providing psychiatric nursing.

Remember: If, on the other hand, the mental disorder is the focus of care, Medicare expects that a psychiatric nurse is involved, Manning says.

If applicable, use an additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298 (Other psychoses).