Internal Medicine Coding Alert

Question: An internist's documentation states, "DM complicated by neuropathy." Should I assign 250.60?


New Jersey Subscriber


Answer: If the patient has type II diabetes--or an unspecified type--and the internist did not state that the patient's diabetes was uncontrolled, you should classify diabetes mellitus (DM) with neurological manifestations as 250.60 (Diabetes with neurological manifestations; type II or unspecified type, not stated as uncontrolled).

Next step: Diabetes manifestation codes 250.4x-250.7x require an additional code to identify the diabetic manifestation, according to CPT's notes following each four-digit code entry. Therefore, your ICD-9 coding is incomplete without the neuropathy code. Check the chart notes for the patient's specific diabetic neuropathic manifestation:

• mononeuropathy (354.0-355.9)
• periphereal autonomic neuropathy (337.1)
• polyneuropathy (357.2). 
 
Identifying the specific manifestation shows the severity or progression of the diabetes and shows the patient may require more complex care. The secondary diagnosis may help justify a higher-level E/M code (such as 99214, Office or other outpatient visit for the evaluation and management of an established patient) because it indicates the internist is dealing with diabetes involving a specific manifestation.

Red flag: Don't routinely code the patient's manifestation. You should list only the complications that the internist addresses at that visit.

Example: An internist treats a type II patient with vision problems for a hypoglycemic incident. You should link 250.82 (Diabetes with other specified manifestations; type II or unspecified type, uncontrolled) rather than 250.52 (Diabetes with ophthalmic manifestations ...) to the appropriate office visit code (99201-99215, New or established patient office visit), because the reason for the visit was hypoglycemia.

Also code any associated ulceration (707.10-707.9) or diabetic bone changes (731.8). If a drug caused the incident, use an E code to identify the drug.