Urology Coding Alert

Question: Our practice sees patients with both type I and type II diabetes, but it appears that ICD-10 doesn’t group the types together like ICD-9 did. Can you explain the difference?

Washington Subscriber

Answer: Under ICD-9, when a patient presents with diabetes, you must determine the fourth digit for 250.xx (Diabetes mellitus) according to the type of diabetic complication the patient has, if any. If the patient presents with diabetes without any complications, your first four digits will be 250.0 (Diabetes mellitus without mention of complication).

Under ICD-9, the fifth digit provides the final two pieces of information on the patient’s diabetic condition: the diabetes type (I or II) and whether it is controlled.

ICD-10 change: Effective Oct. 1, you should no longer flip to the same code section for both type I and type II diabetes. Although you are currently accustomed to starting off with “250” for all diabetes patients, your coding options will expand dramatically under ICD-10.

Type I: You’ll code all type I patients by starting out with the E10 series (Type I diabetes mellitus), and then you’ll move on from there after reviewing the patient’s chart to determine whether any further manifestations exist.

Type II: You’ll code all type II patients by starting out with the E11 series (Type 2 diabetes mellitus), then moving on from there after reviewing the patient’s chart to determine whether any further manifestations exist.

Documentation: Just because type I diabetes has the phrase “juvenile onset” in parentheses following the descriptor, don’t assume that all pediatric patients have type I diabetes. Physicians are treating type II diabetes developed in childhood or adolescence more often than they were a few years ago.

Default: If there is no documentation that actually states type I or type II, the diagnosis code will default to type II diabetes — category E11 (Type 2 diabetes mellitus). You should never assume that a patient has Type I just because she is a “juvenile,” and likewise you cannot assume that an older patient has Type II.

Reference: Official Coding Guidelines I.C.4.a.1 and I.C.4.a.2.