Part B Insider (Multispecialty) Coding Alert

If you don’t know the diabetes type, you should default to this.

You’ve got just two weeks left before ICD-10 becomes a reality, so if you missed a key ICD-10 concept in your training, you could be setting yourself up for some headaches in the very near future. Check that you haven’t missed these details by looking at these five questions and answers.

Brush Up Your Basics

Question 1: In ICD-10-CM, how many characters can a valid diagnosis be?

Answer 2: Your codes can be three to seven characters in length.

Reference: Official Coding Guidelines Section I.A.2

Question 2: When you see an Excludes 2 note below an ICD-10-CM code, what does it mean?

Answer 2: A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

Reference: Official Coding Guidelines Section I.A.12

Confront Borderline Diagnoses for Question 3

Question 3: Your physician documents the patient has “borderline diabetes.” How should you report this?

Answer 3: When your physician documents a borderline diagnosis at the time of discharge, then you should code the condition/disease as confirmed — unless the classification provides a specific entry (e.g., borderline diabetes). If a borderline condition has a specific index entry in ICD-10-CM, then you should code this diagnosis that way. Since borderline conditions are not uncertain diagnoses, you should not make any distinction between the care setting (inpatient versus outpatient).

Important: Whenever the documentation is unclear regarding a borderline condition, you should query your physician for clarification.

Reference: Official Coding Guidelines Section I.B.17

Highlight Your “Default” When Type Not Documented

Question 4: Your physician sees a 16 year-old patient for diabetes but does not specify the type. What should you do?

Answer 4: You should assign a code from category E13.- (Other specified diabetes mellitus). The age of the patient is not the sole determining factor for the type of diabetes.

Default: When the type of diabetes mellitus is not documented, the default category is E11 (Type 2 diabetes mellitus). You should never assume that a patient has Type I just because she is a “juvenile,” and likewise you cannot assume that an older patient has Type II.

Reference: Official Coding Guidelines I.C.4.a.1 and I.C.4.a.2

Zero In On Your Primary Diagnosis in Chemo Scenario

Question 5: Your physician admits a patient for chemotherapy. She develops uncontrolled nausea and vomiting following the treatment. She is receiving the chemotherapy for ovarian carcinoma with lung metastasis. What should be your principal/first-listed diagnosis?

Answer 5: You should report Z51.11 (Encounter for antineoplastic chemotherapy). When a patient is admitted for the purpose of chemotherapy and develops complications such as uncontrolled nausea and vomiting or dehydration, the principal or first-listed diagnosis is Z51.11.

Reference: Official Coding Guidelines, I.C.2.e.2 and I.C.2.e.3

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