Primary Care Coding Alert

Tip: Look for type, status when assigning diabetes diagnosis

You can submit diabetes claims with confidence if you correctly code this real-world case study.
 
Even before ICD-9 changed 250.xx's (Diabetes mellitus) fifth-digit descriptors, diabetes coding confused many family physician coders. But you can easily determine 250's fifth digit if you follow these steps:

1. Choose Type I or Type II

First, look at the patient's diabetes type. Code type I diabetes with a fifth-digit of "1" or "3." Use a fifth-digit subclassification of "0" or "2" for type II diabetes. "The FP needs to document this differentiation," says Marie Felger, CPC, a member of the American Academy of Family Physicians (AAFP) FPM Coding & Documentation review panel.

2. Determine Controlled or Not

To choose between 250.x0 and 250.x2, look at the patient's diabetic condition. Does the FP note that the patient's diabetes is controlled or not? Assign 250.x0 for controlled diabetes, and 250.x2 for uncontrolled diabetes.
 
Pitfall: Your FP may not note that the patient's diabetes is "controlled," but you can still submit the correct code without further information.
 
Here's how: Report a fifth digit of "0" if the FP doesn't state that the patient's diabetes is uncontrolled. "The descriptor really indicates that the patient's diabetes is controlled," Felger says. "Not stated as uncontrolled" allows you to assume that the patient's diabetes is controlled when the FP doesn't document that detail.

3. Disregard Age and Onset

When you code your FP's diabetes chart note, you can ignore other terms, such as "adult" and "new onset." "New onset has nothing to do with the fifth-digit code selection," Felger says.
 
Key words: Simply zoom in on the patient's diabetes type and status. Those two items determine the fifth digit, Felger says.

Test 3-Point Process With This Quiz

See if you can apply the above-mentioned three steps in this coding scenario:
 
A patient came into our office with adult new onset type II insulin dependent diabetes, writes Jessica R. Skelton, coder at Athens Family Practice in Athens, Tenn. "What diagnosis code should I use?"
 
In Skelton's example, the FP documents that the patient has type II. Therefore, you should report either 250.x0 or 250.x2.
 
To choose between a fifth-digit of "0" and "2," look for the diabetes' status. Because the FP doesn't mention that the patient's diabetes is uncontrolled, you should assign 250.x0, Felger says.
 
You can cross out "adult" and "new onset." Neither of these terms matters when you're selecting 250's fifth-digit subclassification.
 
Final step: To choose the fourth digit, look for any complications. Because the FP doesn't mention any diabetes complications, assign a fourth digit of "0."