OASIS Alert

Be sure each manifestation gets its own treatment.

Question: Our 72-year-old male patient with uncontrolled type II diabetes and diminished visual acuity due to diabetic macular edema has a diabetic ulcer over his left first metatarsal head.

Answer: When you have multiple kinds of diabetic manifestations -- such as macular edema and ulcers -- you must list multiple diabetes codes, says Joan Usher with JLU Health Record Systems in Pembroke, Mass.

The fourth digit you select for a code in the 250.xx category links the complication to the diabetic disease. In your patient's case, that means listing 250.82 for your patient's diabetic ulcer along with 250.52 for your patient's diabetic macular edema.

Follow each diabetes code with the appropriate code for the specific manifestations. When coding for diabetes, the fifth digit of 250.xx identifies the type of diabetes and whether the diabetes is controlled or uncontrolled, Usher says.

In your patient's case, the medical record specifies that his diabetes is uncontrolled, so it's appropriate to list 2 as your fifth digit. Absent this detail, you would select the default fifth digit for codes in the 250.xx category -- "0."

Coding guidelines and the note at 362.07 indicate that you must also code for diabetic retinopathy when you report diabetic macular edema. Because you don't have specific information about the level of retinopathy, use the 362.01 code. The diminished visual acuity can be appropriately coded in this example as well.

Knowing this, code for your patient as follows, Usher says:

• M1020a: 250.82 (Diabetes with other specified manifestations; type II or unspecified type, uncontrolled);

• M1022b: 707.15 (Ulcer of other part of foot);

• M1022c: 250.52 (Diabetes with ophthalmic manifestations; type II or unspecified type, uncontrolled);

• M1022d: 362.07 (Diabetic macular edema);

• M1022e: 362.01 (Diabetic retinopathy NOS);

• M1022f: 369.20 (low vision, NOS).

You can also list V58.67 (Long-term [current] use of insulin) if your type II patientuses insulin, Usher says. But it's not appropriate to list this code for a type I diabetic because the insulin code is inherent in the 250.x1 and 250.x3 codes.