Ophthalmology and Optometry Coding Alert

Deletions don't mean you can ignore insulin dependence completely He may no longer rely on insulin use to determine a patient's diabetes type, but your ophthalmologist should still document whether a patient takes insulin.

To help you accurately report insulin use, CMS created the new ICD-9 code V58.67 (Long-term [current] use of insulin). You should list V58.67 for any patient who takes insulin regularly, says Beth Fisher, medical systems specialist with the National Center for Health Statistics (NCHS) in Hyattsville, Md.

Watch out: Don't let the phrase "long-term" in the code's descriptor confuse you. Neither CMS nor NCHS has defined "long-term," Fisher says. And, because the descriptor lists "current" beside the phrase, you can assign V58.67 for nearly "anybody who is using insulin," she adds. For instance, you could use the code for a gestational diabetes patient (648.8x) who takes insulin.

V codes are secondary: Typically, you should use V58.67 as a secondary diagnosis code to identify patients with type II diabetes who take insulin. That means you will likely report V58.67 with the following fifth digits for code 250.xx (Diabetes mellitus):
   0 - type II or unspecified type, not stated as uncontrolled
   2 - type II or unspecified type, uncontrolled. Example: The physician diagnoses a patient with type I diabetes with ophthalmic complications (250.5x, Diabetes with ophthalmic manifestations), and the patient is insulin-dependent. In this case, you may be able to list V58.67 as a secondary diagnosis code.

Follow the rules: You should apply V58.67 consistent with both official coding rules and your facility's V code usage policy, says Alison Nicklas, BS, RHIT, CCS, director of education and training for Precyse Solutions in King of Prussia, Pa. Some facilities maintain specific policies about when and how you should use V codes. "I would recommend [that you assign V58.67], because it provides specific information that can demonstrate the severity of diabetes" - something that a type II or unspecified diabetes code cannot do alone, she says.