Primary Care Coding Alert

ICD-10-CM changes reflect a rise in reported cases.

The annual revisions to ICD-10-CM are on their way!

Released on June 13, 2017, these new codes “are to be used for discharges occurring from October 1, 2017 through September 30, 2018 and for patient encounters occurring from October 1, 2017 through September 30, 2018,” according to CMS. So now is the perfect time to prepare for some big changes that could well impact your practice in October.

Read on to get the lowdown on some of the ICD-10 changes that will matter most to you.

Introducing E11.10 and E11.11

One set of changes that will affect many practices occurs in Chapter Four, “Endocrine, nutritional and metabolic diseases,” of ICD-10-CM. The new code book adds a new subdivision, E11.1 (Type 2 diabetes mellitus with ketoacidosis), to the E11 (Type 2 diabetes mellitus) codes. This new subdivision includes two codes: E11.10 (… without coma), and E11.11 (… with coma).

Diabetic ketoacidosis (DKA) occurs when the body breaks down fat instead of glucose to use for energy, producing ketones that make the blood more acidic. According to the American Diabetes Association, “DKA may happen to anyone with diabetes, though it is rare in people with type 2.”

However, recent studies have noted that the number of type 2 patients presenting with DKA has been increasing. So, one main reason why the WHO is introducing these new E11.1 codes is to reflect the growing trend in cases of type 2 DKA. As Suzan Hauptman, MPM, CPC, CEMC, CEDC, AAPC Fellow, senior principal of ACE Med Group in Pittsburgh, explains, “If the World Health Organization [WHO] starts to see an increase in a particular condition, [or] if providers petition to have it added, the WHO will look at the data and determine if a code should be added, changed, or deleted.”

Subdivisions Help You Get More Specific

Another possible reason for the change, according to Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, is to “bring E11 in line with the other families (E08-E13), which already have such codes.”

Code series E08 (Diabetes mellitus due to underlying condition), E09 (Drug or chemical induced diabetes mellitus…), E10 (Type 1 diabetes mellitus …), and E13 (Other specified diabetes mellitus …) all feature XXX.1 (… with ketoacidosis) as a subdivision containing two codes: XXX.10 (… without coma) and XXX.11 (… with coma). So, the addition of the E11.1 codes is consistent with other code series and allows greater specificity for coders.

What Not to Do with DKA Dx

To document a patient with type 2 DKA, “the best code prior to this change was E11.69” (Type 2 diabetes mellitus with other specified complication), according to Hauptman. Moore agrees, adding that you would add E87.2 (Acidosis) “since there is an instruction after E11.69 to use an additional code to report the complication and since the Excludes1 instruction after E87.2 does not include E11.”

This means that the rule change on October 1 allows coders to use just one code, either E11.10 or E11.11, instead of two (E11.69 and E87.2). The change allows for more precision when assigning a diagnosis code. Or, to put it another way, the change allows “the documentation to keep up with the changing specificity requirements of the codes” as Hauptman sees it.

Both Hauptman and Moore also caution that coders should not be using E13.1 (Other specified diabetes mellitus with ketoacidosis) to report type 2 DKA now or in the future because, as Moore explains, “one of the Excludes1 currently under E13 is type 2 diabetes (E11).” Significantly, this particular Excludes1 is also one of the ICD-10-CM deletions that will become effective Oct. 1. So, using this code to document type 2 DKA is not only incorrect now, but it will continue to be so once the 2018 ICD-10-CM changes take effect.

For more info on the new ICD-10-CM changes, go to https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.