Wiki Diabetic complications

[skeene]

Lots of confusion with this topic!! If a doctor documents a member has for example
Diabetes with renal complications 250.40, but does not state what the manifestation is ie: CKD, nephritis. When billed they code the 250.40.

In my eyes this would be correct since they have not stated the complication. I have someone within my organization stating that we should delete the 250.40 and only code 250.00 because CKD or nephritis was not specified. Now I understand if they don't specify CKD or nephritis that we cannot code 585 along with the 250.40, but why should we delete the 250.40 and drop it to only a 250.00 when clearly they did document diabetes with renal complications??

Must the two codes be together always?? or can the primary diabetes code such as 250.40 be billed/coded by itself??

 

[jaoconne]

This one is a bit of a debate with fellow billers in my office as well; but as the only coder, I can't see how you could bill the manifestations code without listing the manifestations. The point of using the more specific code of 250.40 (DM with renal manifestations) is to indicate that the patient's DM is existed long enough to have caused a renal dx. It denotes that the DM has reached such a severe stage in the pt that it is now affecting other organs. Therefore, they need to be included, and I would go back and query the physician. Now, I have seen some payers let them slip through and pay them on their own, but sooner or later, someone will catch them in an audit (and you don't want to have to go through your records to fight a recoup later...). Also, you need to have your staff (and physicians) understand they need to be specific about these dxs, as with ICD-10, the DM and manifestations will be one code. Better the documentation and billing be on key now, in my opinion.

 

[LilMissCoder]

I do HCC coding for an ACO and we use these codes quite often.

It comes down to this....Read the code descriptions in your book.

Under 250.40, DM with renal manifestations it very clearly states that you need to use an additional code to identify the manifestation.

When I have a provider who has documented 250.40 but not the manifestation, I query the provider and ask him what the manifestation is. Once his note is updated, I add the manifestation and bill the charge. The only time I would change the 250.40 to 250.00 is if the provider is unable to provide the manifestation information, and I've rarely run into that situation.

It does help to have a good relationship with your providers. My providers welcome our queries, because they know that we are working in their best interest.