Primary Care Coding Alert

Question: In the October 2004 Family Practice Coding Alert, you suggest coding diabetes complications (250.7x) for a patient who had diabetes mellitus for 30 years and had diabetic peripheral circulatory disorders from the disease. He then received a pancreas transplant, which essentially "cured" him of the diabetes.

I question your recommendation to report 250.7x in this instance. I would think that diabetes is inherent in this code, because the fifth-digit subclassification compels you to determine the type of diabetes. Why would you suggest reporting 250.7x when the patient no longer has diabetes?

Tennessee Subscriber Answer: Even though the transplant in effect cured the patient's diabetes, the individual will continue to have all the complications, which will never get better. Therefore, when your family physician treats conditions caused by diabetes, such as foot problems, you may code the appropriate diabetes complication code, such as 250.7x (Diabetes with peripheral circulatory disorders).

You will, however, probably use a fifth-digit subclassification of "0" (type II or unspecified type, not stated as uncontrolled) or "1" (type I [juvenile type], not stated as uncontrolled). The patient's diabetes is "cured," so the disease is controlled or "not stated as uncontrolled."