Pathology/Lab Coding Alert

Question: A physician orders repeated blood glucose tests for a patient diagnosed with type II diabetes, which he assigns the diagnosis code 250.00. But the physician also noted that the patient is on insulin therapy, and I wonder if we need to indicate that somehow in our coding.


New York Subscriber

Answer: When you bill for the glucose test (82947, Glucose; quantitative, blood [except reagent strip]), the first ICD-9 code you should list is the one given to you by the physician: 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled). ICD-9 clarifies that you can use the fifth-digit "0" even if the patient requires insulin.

But ICD-9 also supplies a code that you should use to show that the patient now takes insulin, since the ordering physician supplied that information. The code is V58.67 (Long-term [current] use of insulin). Using the code provides additional information regarding the severity and treatment of the patient's diabetes, which could be significant when the payer assesses medical necessity for repeat glucose tests.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.