Wiki help with DM coding

[perkins05]

We have an insurance auditor that is telling us that we must code both DM (250.00) and DM with renal manfestiations (250.40 & 585.3) on the same claim.

Is was my understanding IF the patient has DM with manfestation that DM was covered by the 250.40 code. I think adding 250.00 to these encounter is over kill.

Any suggestions or opinions are greatly appreciated!

Thanks

 

[mitchellde]

the insurance auditor is totally incorrect! your patient cannot have "no complication", and a complication at the same time. 250.00 states with no complication. The coding guidelines also state this.

 

[Evelyn Kim]

Debra is totally correct, I always instruct my providers that once a complication exists then the 250.00 has to go away becuase the complication exists and therefore the uncomplicated no longer exists.

 

[perkins05]

Thanks Ladies