Wiki Coding for Diabetes with A1C results

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rmooney1114

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Hello, I have a question in regards to HCC codes. If a patient comes in and the provider states the patient is there to follow up on the DMII, and the provider documented that the patients' A1c levels are @ a 7.1, can the coder then documented Diabetes Type 2 with Hyperglycemia, or does the provider need to specifically state "Patient has diabetes type 2 with hyperglycemia.. This seems to be a constant topic of discussion in our coding dept, so I am looking for some answers and references if possible.
Thank you
 
A coder cannot interpret lab results to assign a code. No internal HCC coding process should supercede either the ICD-10 official guidelines for coding and reporting or the AHA coding clinic. The provider must state diabetes with hyperglycemia.
 
Thank you so much Pam. Those were my thoughts as well, but I needed some back up in order to prove my point here with the rest of the coding staff lol.. :D
 
Even in a clinical setting, 7 is considered controlled for a diabetic. If it was like 9 or more, I might do a query if possible. But the best you can do is E11.9 unless it does say uncontrolled, in which you would change to E11.8

If they are on insulin or oral hypoglycemics, those are code also Dx as of 2017 code year.
 
the provider must document hyperglycemia or hypoglycemia, and not just uncontrolled. this was clarified in the 2017 code set and explained in the 1st quarter 2017 coding clinic. The alpha listing now states
Diabetes
uncontrolled
meaning hyperglycemia
meaning hypoglycemia
 
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