Wiki E11.9 and E11.65 billed together?

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Coder07

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Hello,
I have some providers billing both E11.9- Type 2 DM without complications and E11.65 Type 2 DM with hyperglycemia I messaged one of our providers and she said "You can have no complications like no renal issues, neuropathy etc, but still have hyperglycemia.".... now I am just a coder but I thought having hyperglycemia is a complication? Any thoughts?
 
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Coder07 said:
Hello,
I have some providers billing both E11.9- Type 2 DM without complications and E11.65 Type 2 DM with hyperglycemia I messaged one of our providers and she said "You can have no complications like no renal issues, neuropathy etc, but still have hyperglycemia.".... now I am just a coder but I thought having hyperglycemia is a complication? Any thoughts?
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You leave off the E11.9. It's not appropriate to bill Diabetes, unspecified with a Diabetes w/complication code. The diabetes is already represented in the E11.65.

I personally would just remove the E11.9 code myself. As a coder, you should be able to follow correct diagnosis coding guidelines. I wouldn't want to work for a provider who wouldn't give a coder the flexibility for such a simple guideline adjustment.

BTW, payers are starting to use invalid diagnosis coding as reasons to reject claims.
 
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If they've been in practice for awhile, you could try explaining it like "Remember how in ICD-9, there was a code for uncontrolled diabetes? That's what E11.65 is. E11.9 is for controlled diabetes. You can't be both controlled and uncontrolled, so you have to choose." You can remind them that uncontrolled is based on their judgment; if they think it's uncontrolled, document it as such. The ICD-10 Police aren't going to come and throw them Coding Jail because Dr. so-and-so decided a 9 was uncontrolled and Dr such-and-such doesn't code uncontrolled until it goes to 11.
 
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