OASIS Alert

Watch for more types of diabetes.

Most likely, you can practically code for diabetes in ICD-9 while you’re asleep. With ICD-10, the codes you’ll report in OASIS-C1 items M1021/M1023 will get a thorough make-over, but they shouldn’t cause too many restless nights. Take the time to become acquainted with the changes ahead of time and selecting the right codes will be a dream.

Know the Categories

You’ll have five diabetes categories to choose from in ICD-10, says Angie Comfort, RHIT, CDIP, CCS, AHIMA-approved ICD-10-CM/PCS Trainer, director of HIM practice excellence for AHIMA. These include:

• E10.-- (Type 1 diabetes mellitus);
  
• E11.-- (Type 2 diabetes mellitus);
  
• E08.-- (Diabetes mellitus due to underlying condition);
  
• E09.-- (Drug or chemical induced diabetes mellitus); and
  
• E13.-- (Other specified diabetes mellitus).
  

As in ICD-9, if the medical record doesn’t specify which type of diabetes your patient has, the official coding guidelines for ICD-10 require you to default to Type II.

While Type I and Type II diabetes should be familiar to an experienced ICD-9 coder, the remaining three types give greater specificity than is available in ICD-9.

If your patient has developed diabetes as the result of an underlying condition like cystic fibrosis, you’ll look to E.08--, Comfort says. When the diabetes is caused by poisoning from drugs or chemicals, E09.-- is the code range. And for patients with diabetes caused by other conditions such as postpancreatectomy diabetes, you’ll report an E13.-- code. The E12.-- category is reserved for future use.

One Code for Diabetes and Manifestation

You’ll also need to know whether your patient has any diabetic manifestations. In ICD-10, the fourth characters of a diabetes code indicate whether and what kind of manifestation a diabetic patient has. These fourth characters range from 0 to 9 and are broken down into physiological categories, such as neurological, renal, and ophthalmic, as well as unspecified complications and without complications.

Fifth and sixth characters for diabetes codes in ICD-10 go on to specify the manifestation. As a result, one code can cover both the type of diabetes and the manifestation. For example, E10.42 (Type 1 diabetes mellitus with diabetic polyneuropathy).

Out-of-control: In ICD-10, if your patient’s diabetes is inadequately controlled, out of control, or poorly controlled, you’ll list a code for your patient’s diabetes with hyperglycemia, such as E11.65 (Type 2 diabetes mellitus with hyperglycemia). This is a change from ICD-9’s method of requiring you to report “not stated as uncontrolled” or “controlled” with every diabetes code.

Insulin use: In ICD-10, you’ll list Z79.4 (Long term [current] use of insulin) to indicate long-term insulin use in patients with diabetes due to an underlying condition (E08), patients with drug- or chemical-induced diabetes, patients with Type 2 diabetes (E11), and patients whose diabetes is classified to E13.-- (Other specified diabetes mellitus). This code isn’t appropriate for patients with Type 1 diabetes.

Watch the Alphabetic Index

The alphabetic index of your ICD-10 coding manual can be tricky to navigate when it comes to diabetes, Comfort cautions. If you reference the term “diabetes” and move to the first sub-term “with” you could wind up with the wrong code. That’s because the codes listed here all refer to Type II diabetes. Make sure you follow through the terms to find the appropriate type rather than ending your search at “with.”

And always verify the code you find with the tabular list, even if you’re an experienced coder, Comfort reminds. This is where you’ll find “use additional code,” “code also,” and “code first” notes. For example, if your patient has drug or chemical induced diabetes, the tabular list provides important sequencing instructions that you would miss if you ended your search in the alphabetic index.

Coding scenario: Your patient was discharged from the hospital after a problem with Type I diabetes in ketoacidosis. Currently, the diabetes is poorly controlled. The patient has a new insulin pump and is struggling to maintain glucose control. Your agency has orders for skilled nursing to monitor glucose levels and provide dietary counseling for a diabetic diet and training on the insulin pump usage. Comforts suggest the following ICD-10 codes for this patient:

• E10.65 (Type 1 diabetes mellitus with hyperglycemia);
  
• Z71.3 (Dietary counseling and surveillance); and
  
• Z46.81 (Encounter for fitting and adjustment of insulin pump).