Pediatric Coding Alert

You can avoid miscoding diabetes claims if you take two steps and a coding quiz.
 
Because ICD-9 2005 eliminates 250.xx's (Diabetes mellitus) references to insulin, you may not know how to assign diabetes' fifth digit. Here's what you should do to ensure you correctly report diabetes diagnoses.

Look for/Report Diabetes Type

Your practice will improve its diabetes coding accuracy if you implement these tips:

 1. Pediatricians should acquaint themselves with 250.xx's new diagnostic differences.
 2. Pediatric coders need to ask their pediatricians what type of diabetes a child has. That way, the coder can report the appropriate diagnosis, says Jeffrey Linzer Sr., MD, MICP, FAAP, American Academy of Pediatrics representative to the ICD-9-CM editorial advisory board.

Find Function Information for Fifth Digit

To make sure your staff doesn't miscode any claims this fall, give them this diabetes coding quiz:
 
Example 1: A pediatrician performs an annual established patient preventive medicine service for a 7-year-old-boy whose pancreatic beta cells aren't functioning (has juvenile diabetes) and whose diabetes is well-controlled.
 
Answer 1: Report 250.03 (Diabetes mellitus without mention of complication; type I [juvenile type], uncontrolled) with 99212-99215-25 (Office or other outpatient visit for the evaluation and management of an established patient; significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and V20.2 (Routine infant or child health check) linked to 99393 (Periodic comprehensive preventive medicine re-evaluation and management of an individual ...; late childhood [age 5 through 11 years]). Because the child doesn't have any insulin-producing cells, you should report type I diabetes: 250.x1 or 250.x3. The pediatrician states the patient's diabetes is controlled, so submit type I, uncontrolled with a fifth-digit subclassification of 3.
 
Example 2: A pediatrician diagnoses an overweight teen-ager whose pancreatic beta cells aren't producing enough insulin with maturity-onset-diabetes-in-youth (MODY) and recommends a diet and exercise regime to control the child's diabetes.
 
Answer 2: You should submit 250.02 (... type II or unspecified type, uncontrolled) as the diagnosis and 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient) for the encounter. The patient's pancreatic beta cells aren't functioning properly. Therefore, you should report type II diabetes. Because the pediatrician notes that the child's condition is uncontrolled, assign a fifth-digit subclassification of 2.