Practice Management Alert

Ratchet Up Your Diabetes Diagnosis Coding Savvy

Billers who have not mastered the new ICD-9 coding guidelines for diabetes mellitus are already behind. Don't let the wave of new information overwhelm you--we-ve boiled it down to the essentials with the following advice.

You now have more specific instructions for reporting diabetes mellitus (DM), especially for codes from the 250 category,  says Anita Hart, RHIA, CCS, CCS-P, ICD-9-CM and ICD-10 product manager for Ingenix Inc.

Good news: You won't have to pick just one code from the 250 series to describe all the patient's associated conditions if she has multiple ones.

Bad news: That means you have to describe all the conditions. Let's say a patient has had uncontrolled insulin-dependent diabetes mellitus (IDDM) for five years and now has cataracts. When this patient comes in for a visit, you should list the following ICD-9 codes on the claim:

- 250.52 (Diabetes with ophthalmic manifestations; type II or unspecified type, uncontrolled) for the IDDM.

- 366.41 (Diabetic cataract) for the cataracts

- V58.67 (Long-term [current] use of insulin) to represent the patient's insulin dependency.

Remember that the new guidelines require a fifth digit on all category-250 codes to identify the type of DM and whether the condition is controlled or uncontrolled, Hart says.

The DM guidelines for 2006 also ask you to report routine insulin use and problems with insulin pumps. For type II patients who routinely use insulin, you-ll report V58.67 (Long-term [current] use of insulin). But you should avoid this code in cases in which the physician just administered insulin temporarily to bring a type II patient's blood sugar under control during an encounter, Hart says. When the patient's insulin pump malfunctions, you-ll report the following code sequences:

Overdose 

- 996.57--Mechanical complication due to insulin pump (primary diagnosis)

- 962.3--Poisoning by insulins and antidiabetic agents (secondary diagnosis)

- 250.xx--Diabetes mellitus code based on documentation (secondary diagnosis), poisoning with manifestation of overdose

Underdose

- 996.57--Mechanical complication due to insulin pump (primary diagnosis)

- 250.xx--Diabetes mellitus code based on documentation (secondary diagnosis), complication with mani-festation of disease.