Internal Medicine Coding Alert

Question: When I'm choosing the "type" of diabetes, at what age is the patient considered to be an adult instead of a juvenile? Does the patient's age even matter?

California Subscriber

Answer: Typically, you don't have to use a patient's age to determine whether you diagnosis a patient with either type I or type II diabetes mellitus (250.xx). To pick the right diabetes type, make sure you know each type's definition and Medicare's requirements for diagnosis.

Type I diabetes is an autoimmune disease that destroys the pancreas' beta cells and leads to insulin deficiency. Type II is familial hyperglycemia that occurs primarily in adults but can also occur in children and adolescents. This form of diabetes results from an insulin resistance with a multiple etiology and is not totally understood. Gestational diabetes is any degree of glucose intolerance with onset or first recognition during pregnancy. 

You should diagnosis diabetes mellitus using the following criteria: a fasting blood sugar greater than or equal to 126 mg/dL on two different occasions; a two-hour post-glucose challenge greater than or equal to 200 mg/dL on two different occasions; or a random glucose test over 200 mg/dL for a person with symptoms of uncontrolled diabetes.