Pediatric Coding Alert

Question: Our practice sees patients with both type I and type II diabetes, but it appears that ICD-10 doesn’t group the types together like ICD-9 did. Can you explain the difference?

Answer: Under ICD-9, when a patient presents with diabetes, you must determine the fourth digit for 250.xx (Diabetes mellitus) according to the type of diabetic complication the patient has, if any. If the patient presents with diabetes without any complications, your first four digits will be 250.0 (Diabetes mellitus without mention of complication).

Under ICD-9, the fifth digit provides the final two pieces of information on the patient’s diabetic condition: the diabetes type (I or II) and whether it is controlled.

ICD-10 Change: Effective Oct. 1, you’ll no longer flip to the same code section for both Type I and Type II diabetes. Although you are currently accustomed to starting off with “250” for all diabetes patients, your coding options will expand dramatically under ICD-10.

Type I: You’ll code all Type I patients by starting out with the E10 series (Type I diabetes mellitus), and then you’ll move on from there after reviewing the patient’s chart to determine whether any further manifestations exist.

For instance: A seven-year-old patient presents with Type I diabetes and is in ketoacidosis, but is not in a coma. In this case, you’ll look to E10 as your first three characters to reflect the Type 1 diagnosis, followed by the additional digits “10” to reflect that the patient is in ketoacidosis without a coma. Therefore, the full code will be E10.10 (Type 1 diabetes mellitus with ketoacidosis without coma).

Type II: You’ll code all Type II patients by starting out with the E11 series (Type 2 diabetes mellitus), then moving on from there after reviewing the patient’s chart to determine whether any further manifestations exist.

For instance: You see a 17-year-old obese patient with Type II diabetes and hypersmolarity, but who is not in a coma. In this case, you’ll go straight to E11.x and scroll down to E11.00 (Type 2 diabetes mellitus with hypersmolarity without nonketotic hyperglycemic hypersmolar coma [NKHHC]).

Documentation: Just because Type I diabetes has the phrase “juvenile onset” in parentheses following the descriptor, don’t assume that all pediatric patients have Type I diabetes. It is becoming increasingly common for pediatricians to treat Type II diabetes developed in childhood or adolescence.

Helpful in determining whether a patient has Type I or Type II diabetes is the results of a C-peptide assay, which measures insulin production and can indicate which type of diabetes is present. These test results may be important as you select the most accurate ICD-10 code, so check the documentation for those results. If there is no documentation that actually states Type I or Type II, the diagnosis code will default to Type II diabetes. This could be an issue with a Type I diabetic child, so your accurate documentation is paramount in ensuring that your patients receive an accurate ICD-10 code.