Wiki Diabates coding with and without manifestations

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erjones147

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Diabetic patient with known retinopathy presents for a blood sugar check and med refills. New FNP insists on only coding 250.02 instead of 250.52, saying that since the patient was not complaining of retinopathy issues for that visit, 250.52 is not appropriate

My understanding is that when diabetes is known to have a permanent manifestation, the combo code must always stay in effect

Guideline 1.A.6 seems to side with me, but is it clear that the combo code should be used when the manifestation is not the reason for the visit? My argument is that it does not matter if the manifestation is present, since it is permanently associated with the diabetes

Anything in writing out there that confirms either of our viewpoints?
 
My concern is that although the patient is diabetic, there is no stated link to the known retinopathy the way you posed your scenerio. We cannot assume the link just because both conditions were mentioned; the DM and complication must be linked by the provider (eg, diabetic retinopathy or retinopathy due to/secondary to diabetes). "Diabetic patient with known retinopathy" simply states two conditions co-existing but did not provide a cause and effect link. The term diabetic described the patient, not the retinopathy.

I do not agree with the reason your FNP didn't want to code the diabetic complication, but based on the wording in your post, I wouldn't code it either.

The guideline path you cited gives sequencing advice. IV.J and IV.K advise about coding chronic diseases and all documented co-existing conditions. I agree with your reasoning that whether the patient is complaining about a condition or not, we are to code all chronic and co-existing conditions being documented and managed.

(One more concern: Was the DM stated as uncontrolled to validate the 250.02?)

Based on your exact wording, I would code 250.00 and 362.10.
 
I am with terribrown on this. The way you have it stated is not a diabetic complication and is not stated as out of control. Remember the diagnosis must be documented in the providers own words. They cannot use a code to represent the patient diagnosis.
 
Diabetic manifestation codes are not always permanent. I was working in ophthalmology. Sometimes a patient would come in and the doc would see evidence of retinopathy in the eye, but with improved glucose control, he may not see it in six months.

You always have to consider the reason for the visit for diagnosis coding. The FNP is not treating the retinopathy, so she does not know if it is still a problem. As long as it was stated as uncontrolled, I would code 250.02.

The exception to this would be if say the FNP says the patient is getting laser treatments for the retinopathy, then it is still a known problem and the manifestation code could be used. I do agree with the previous comments about ensuring the link between the retinopathy and diabetes to use the manifestation code.
 
hello, I don't have ICD 10 book with me or access to Encoder (it's Sunday) but I believe that Diabetes in the Index list retinopathy under the word "with". Per coding guidance, 'with', 'due to' represent the linkage between 2 conditions Unless the documentation says otherwise. So, I would code diabetes with retinopathy as a complication of diabetes. You can revisit the coding guidance rules annually to remember it all! :)
 
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