Wiki Diabetes with and without complications

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angelalhale

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If a provider documents both diabetes with CKD (E1122) and diabetes without complications (E119) in the assessment and plan and the coder added both to the claim. Would we loose the higher HCC code (E1122) in an audit because of the conflicting documentation? This has become an issue for our practices and we are worried that only the E119 will count in a CMS audit. Thanks for any help.
 
If there is support for the CKD then you would code E11.22-- The provider often times can copy and paste, but it depends on what is documented to as to what is captured.
 
Angela, E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease. This code is used when a patient has type 2 diabetes and chronic kidney disease, and the provider has not stated they are unrelated. Additional codes can be used to identify the stage of chronic kidney disease, dialysis status, and control. Diagnosis ICD 10 E11.9 cannot be billed if E11.22 supported by documentation; contradiction issue.

Kindest regards,
 
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