Pediatric Coding Alert

1. Select the fourth-digit code based only on the complications that the physician addresses at a particular visit. For instance, if a Type I pediatric patient with vision problems is seen in the office after an episode of ketoacidosis, you should link 250.1x (Diabetes with ketoacidosis) rather than 250.5x (Diabetes with ophthalmic manifestations) to the appropriate office visit code (CPT 99201 -99215 ) because the reason for the visit was hyperglycemia.

2. Type II patients do not usually require insulin injections. When a type II patient requires insulin shots, you may assume the patient is insulin-dependent and erroneously select a fifth digit (1 for controlled, 3 for uncontrolled) for Type I DM instead. Remember that whether the patient takes insulin shots doesn't matter. What's important is the type of diabetes he or she has. In this case, use 0 or 2 depending on whether the DM is controlled.

3. If the physician does not state "uncontrolled" in the documentation, you may not code the condition as "uncontrolled" based on abnormal glucose readings in the patient's chart.