Internal Medicine Coding Alert

Question: I am coding a claim for which the notes indicate that the nonphysician practitioner (NPP) provided an E/M service for an established patient with "secondary diabetes w/ renal manifest." Do I have enough information to choose a diagnosis code with these notes?

Michigan Subscriber

Answer: You have enough there to choose 249.40 (Secondary diabetes mellitus with renal manifestations; not stated as uncontrolled or unspecified) for the patient's secondary diabetes.

To paint a complete diagnosis picture for these patients, however, you also need to code the associate condition. Solet's say that the patient's diabetes was caused by Kimmelstiel-Wilson syndrome. On the claim, you'd report the following:

249.40 to represent the patient's secondary diabetes;

581.81 -- Nephrotic syndrome; with other specified pathological lesion in kidney; nephrotic syndrome in diseases classified elsewhere, to represent the Kimmelstiel-Wilson syndrome.