Internal Medicine Coding Alert

Why insulin dependence becomes less important to coding in 2004-2005

Starting Oct. 1, your internist may find it easier to assign diabetes ICD-9 codes (250.x-250.9x). That's because CMS has deleted insulin and non-insulin designations from the fifth-digit descriptors.

CMS recently announced new and revised ICD-9 codes for 2004-2005. When the changes take effect this fall, your physician will need to determine whether the patient's pancreatic beta cells are functioning to distinguish between the diabetes codes' fifth digits, says Beth Fisher, medical systems specialist with the National Center for Health Statistics (NCHS) in Hyattsville, Md. The NCHS and CMS oversee all ICD-9 changes.

Now, internists use insulin and non-insulin designations to determine whether a patient has Type I or Type II diabetes. Physicians also assign fifth digits to correspond with a patient's particular diabetes type.

But the problem with this system is that physicians often assign Type I diabetes for any patient who's taking insulin, even though many Type II patients use insulin, too, says Deborah Arneson, CPC, coding supervisor at Kernodle Clinic, a Burlington, N.C.-based group practice that includes internists.

That's why the insulin deletions are good changes that should alleviate a lot of confusion for physicians, she says.

Remember: Physicians still need to be as accurate as possible when they categorize the patient's type of diabetes, says Bruce Rappoport MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.

"It is ultimately the physician who is responsible for determining which type of diabetes mellitus the patient has," Rappoport says.

How it works: As of Oct. 1, internists should separate the two types of diabetes and choose the fifth digits by using the following methods: