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Primary Care Coding Alert

ICD-9 2005's Biggest Family Physician Change:

Insulin and Age No Longer Matter When Coding Diabetes

Published on Mon Sep 27, 2004

Choose type I or II dx based on pancreatic beta cell condition

Your diabetes coding struggle should come to an end, thanks to ICD-9's simplification of the 250 series. 
 
Starting Oct. 1, you can no longer rely on the patient's insulin use or age when assigning 250's fifth digit. Here's what experts, such as Marie Felger, CPC, a member of the American Academy of Family Physicians (AAFP) FPM Coding & Documentation review panel, say you need to know to accurately report this "biggest ICD-9 2005 change affecting family physician (FP) coders."
 
Don't Use Insulin to Determine Diabetes Type

You won't actually need any new digits with ICD-9 2005's diabetic revision. "The 250.xx (Diabetes mellitus) update simplifies diabetes coding," Felger says. The codes' descriptors eliminate any reference to insulin dependence.

What's new: FP coders can no longer determine 250's fifth-digit subclassification based on a patient's insulin use. ICD-9 cleaned up the diabetes language because type II diabetics may also require insulin, Felger says. Therefore, you can't differentiate between type I and II diabetes based on insulin alone.

Look to Patient's Beta Cell Condition

You instead need to know the condition of the patient's pancreatic beta cells. When the ICD-9 changes take effect at the beginning of October, your physician will need to determine whether the patient's pancreatic beta cells are functioning to distinguish among the diabetes codes' fifth digits, says Beth Fisher, medical systems specialist with the National Center for Health Statistics (NCHS) in Hyattsville, Md. The NCHS and CMS oversee all ICD-9 changes.
 
How it works: As of Oct. 1, FPs should separate the two types of diabetes and choose the fifth digits using the following methods:

 

  • Type I (fifth digit of 1 or 3) - The physician should assign this type when the individual doesn't have any pancreatic beta cells. "These patients need insulin to live," Felger says.
     
  • Type II (fifth digit of 0 or 2) - You should use this designation when a patient's pancreatic beta calls don't function properly, meaning they don't produce enough insulin. Type II diabetics may occasionally need insulin, Felger says. "But diet keeps most type II diabetes under control."

    Ignore Patient's Age

    ICD-9's diabetic revision also shatters another coding myth: Age doesn't matter when coding 250. "The terms 'juvenile type' and 'adult-onset' confused many coders," Felger says.

    Good news: The revised 250.x0 and 250.x2 descriptors eliminates "adult onset." The "adult" definition led some physicians to think that the "0" and "2" fifth digits applied only to adults. But more young people are developing type II diabetes, Fisher says.

    Prepare for Fall Code Implementation

    You have no time to waste in getting your office ready for the new diabetes descriptors. In February, CMS scrapped the 90-day grace period you once had to implement new ICD-9 codes. Medicare based its decision on the HIPAA law that requires you to use the code set that is valid at the time of service, Felger says. Private payers, "especially the big ones, such as Anthem and Blue Cross," may follow suit, which means your practice should be ready to use the revised fifth digits on Oct. 1.
     
    What to expect: Here are the revised fifth-digit descriptors for 250 as they appear in next year's ICD-9 manual:

     

  • 0 - Type II or unspecified type, not stated as uncontrolled. In addition to removing "[non-insulin dependent type] [NIDDM type]," ICD-9 also deleted "[adult-onset type]."

     
  • 1 - Type I [juvenile type], not stated as uncontrolled. ICD-9 deleted "[insulin dependent type] [IDDM]" from the descriptor. But "juvenile type" remains, because physicians are accurately using that designation to assign the "1" fifth digit, Fisher says.

     
  • 2 - Type II or unspecified type, uncontrolled. Again, ICD-9 removed the non-insulin dependent definition. The key to keeping fifth digits "0" and "2" separate is to remember that "0" represents "not stated as uncontrolled." On the other hand, "2" represents "uncontrolled" diabetes.

     
  • 3 - Type I [juvenile type], uncontrolled. You'll no longer find "[insulin dependent type] [IDDM]" in this fifth digit either. The FP will use this digit for "uncontrolled" juvenile-onset diabetes.

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