Primary Care Coding Alert

How well do you know the diabetes drug codes and guidelines?

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1. Among the five primary diabetes types recognized by ICD-10 — E08.- (Diabetes mellitus due to underlying condition), E09.- (Drug or chemical induced diabetes mellitus), E10.- (Type 1 diabetes mellitus), E11.- (Type 2 diabetes mellitus), and E13.- (Other specified diabetes mellitus) — only one, E10.-, does not require you to use an additional code to identify long-term drug use.

Why? “Because patients with type 1 diabetes are, by definition, insulin dependent, there’s no need to use an additional code to report what is otherwise inherent to type 1. So, the E10.- code family does not require an additional code such as Z79.4 [Long term (current) use of insulin] or Z79.84 [Long term (current) use of oral hypoglycemic drugs] to identify long-term drug use to identify control,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Answer 2: ICD-10 guideline C.21.c.3 tells you that the Z79.- (Long term (current) drug therapy) codes “indicate a patient’s continuous use of a prescribed drug … for the long-term treatment of a condition or for prophylactic use,” and that you should not use a code from the category “for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis).”

The guideline does not say at what point during the patient’s use of the drug you should use a Z79.4 code. However, the American Academy of Family Physicians (AAFP) suggests that using the “‘long-term use’ code for any drug is appropriate once that drug has been started. If you prescribe insulin for the first time at an office visit, it is appropriate to add the Z79.4 code to the base diabetes mellitus code you are using” (Source: www.aafp.org/fpm/2013/1100/fpm20131100p22-rt1.pdf).

Answer 3. Type 2 diabetics who are unable to control their blood sugar levels through lifestyle changes can do so in at least two other ways — through oral hypoglycemic and injectable non-insulin drugs. You’ll use Z79.84 if your patient is taking an oral hypoglycemic medication such as glimepiride, repaglinide, or metformin. And you’ll use Z79.899 (Other long term (current) drug therapy) for patients taking injectable non-insulin drugs such as exenatide, liraglutide, dulaglutide, or albiglutide.

Coding alert 1: “If the drugs are injectables administered by the practice, then the practice should report the J code for the drug plus an administration code such as 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular),” Moore notes.

Answer 4. If a type 2 patient is using a combination of drugs, you will need to consult guideline C.4.a.3 closely for code choice. It tells you to do the following:

• For oral hypoglycemic drugs in combination with injectable non-insulin drugs, use both Z79.84 and Z79.899.
• For long-term insulin use in combination with oral hypoglycemic drugs, use “only the code for long-term (current) use of insulin.” “This is echoed by the Excludes1 note under Z79.4 that prohibits reporting Z79.84 in addition to Z79.4,” Moore adds.
• For long- or short-term insulin use in combination with injectable non-insulin drugs, assign Z79.4 and Z79.899.
• For short-term use of insulin in combination with oral hypoglycemic drugs or oral hypoglycemic drugs, do not use Z79.4 “if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.”

Coding alert 2: “Interestingly, there’s an Excludes2 note under Z79.84 that suggests Z94.4 is not included Z79.84 but separately reportable, which seems at odds with the Excludes1 note under Z79.4,” Moore cautions.

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