Pediatric Coding Alert

Question: We have a 17-year-old patient recently diagnosed with diabetes. The notes say type 2, but should I query the provider to clarify, since this patient is a juvenile?

Indiana Subscriber

Answer: It’s more than likely your provider did not make a mistake. While a pediatric patient with diabetes is more likely to be diagnosed with type 1, a diagnosis of type 2 cannot be ruled out. This is borne out by statistics provided by the American Diabetes Association (ADA) that note “in 2014-2015, the annual incidence of diagnosed diabetes in youth was estimated at 18,200 with type 1 diabetes, 5,800 with type 2 diabetes” (Source: www.diabetes.org/resources/statistics/statistics-about-diabetes).

Additionally, just because the patient is young, doesn’t mean they have juvenile diabetes. Take a look at ICD-10 guideline C.4.a.1. The guideline explains that “type 1 diabetes mellitus is also referred to as juvenile diabetes” because “most type 1 diabetics develop the condition before reaching puberty.” However, the guideline goes on to note that “the age of a patient is not the sole determining factor when assigning a diabetes diagnosis.” This means that you should code based on what is documented and what is appropriate according to the guidelines.