Wiki Sliding scale insulin use

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hyb2922crc

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Hello, I'm seeking guidance on whether sliding scale insulin use should be coded to long term insulin use (z79.4). I have researched and have been unlucky in finding any articles that directly addresses this. If you have any information feel free to share and if possible provide rationale and resources. Thank you in advance!
 
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Unfortunately, I have searched for this for years and have yet to find anything definitive. It will basically boil down to company guidelines. My personal opinion, sliding scale just means the amount changes based on the sugar readings, and they may need none at all if their sugars are good, so it should not be captured, but some companies allow for it if the documentation shows they were already on this sliding scale prior to the DOS. I WISH coding clinic would address this even if "query the provider" because at least we would have something in writing.
 
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Long term use of a drug also includes current use, per ICD10data.com. Generally the long-term use codes are to tell the story... the patient comes in, has diabetes, is prescribed insulin. Not all diabetics are prescribed insulin so not all get the long-term drug use code.

We also use long-term drug use codes in pain management to show why we are doing urine drug screens, along with their pain diagnosis.
 
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I would definitely be careful using ICD10data as a source of information. I have found errors in the past, and they are not an official resource that you can use to dispute an audit finding. Though they are very helpful when looking for clues or leads to the information you need.
 
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For Risk Adjustment purposes, CMS will only consider the ICD-10 book and AMA Coding Clinics. Anything else will not do well in an audit.

As for using the Z79.4 for coding a patient using a sliding scale for insulin, it really boils down to documentation. What about the rest of the context in the chart?

I agree with Andie that while we can find articles on the subject of sliding scale insulin, I have not seen any official that could solidify that particular situation. I did find an AAPC article on the matter, but again this is not CMS official and at best be a guide:

https://www.aapc.com/blog/30454-icd-10-coding-snapshot-11/

Hope this is helpful, I also agree that it would be nice to have a Coding Clinic that directly addresses this issue.
 
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I have a question: what is the purpose of coding long-term insulin use? There's no dosage or frequency to show the use. Insulin is not specifically limited to Type 1 or Type 2. So at least in my mind, the whole purpose for assigning an ICD code is to show necessity for that patient to have a supply of insulin, whether they have to use it or not. Insulin will expire and need to be replaced so the ICD shows medical necessity for prescription renewal.
As far as I can tell, it doesn't matter whether it's sliding scale or not; patient needs to have a personal supply. IMO
 
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I have to agree, the patient requires insulin whether it be sliding scale or routine dosing. You use the Z79.4 code to indicate the patient requires and uses insulin and as stated this supplies the medical necessity for what happens next. Always remember the diagnosis codes are the patient’s and they describe the patient. Whether you are coding HCC or an ER encounter. Being on sliding scale insulin means the patient requires insulin at some part of the day in varying doses.
 
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Pathos said:
For Risk Adjustment purposes, CMS will only consider the ICD-10 book and AMA Coding Clinics. Anything else will not do well in an audit.

As for using the Z79.4 for coding a patient using a sliding scale for insulin, it really boils down to documentation. What about the rest of the context in the chart?

I agree with Andie that while we can find articles on the subject of sliding scale insulin, I have not seen any official that could solidify that particular situation. I did find an AAPC article on the matter, but again this is not CMS official and at best be a guide:

https://www.aapc.com/blog/30454-icd-10-coding-snapshot-11/

Hope this is helpful, I also agree that it would be nice to have a Coding Clinic that directly addresses this issue.
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Thank you for your response it was documented in the medication list and diabetes wasn't mentioned in the note. I work in hcc coding and we are allowed to code insulin use if it is documented whether there's a condition it treats or not. What brought me to this is I was studying for the crc and I remember being marked incorrect on a question I answered z79.4 to capture sliding scale.
 
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Need for insulin can also be due to interruption in pancreatic function so surgical or chemotherapy could be a cause too.
 
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hopebradford said:
Thank you for your response it was documented in the medication list and diabetes wasn't mentioned in the note. I work in hcc coding and we are allowed to code insulin use if it is documented whether there's a condition it treats or not. What brought me to this is I was studying for the crc and I remember being marked incorrect on a question I answered z79.4 to capture sliding scale.
Click to expand...

I can see the logic of picking up Z79.4, but I would still be cautious in picking up a possible diabetes code if the documentation doesn't explicitly state such. Remember that you should be able to defend every code picked if chosen for an audit or even in court.

AAPC is also not always correct in their quizzes/exams, as CMS will not consider AAPC as an approved source. I am curious to know what the "correct" answer then is according to AAPC.
 
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Pathos said:
I can see the logic of picking up Z79.4, but I would still be cautious in picking up a possible diabetes code if the documentation doesn't explicitly state such. Remember that you should be able to defend every code picked if chosen for an audit or even in court.

AAPC is also not always correct in their quizzes/exams, as CMS will not consider AAPC as an approved source. I am curious to know what the "correct" answer then is according to AAPC.
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I used a non aapc entity for studying when I sat for the the crc exam. I've been looking for clear guidance on coding sliding scale insulin use. In my opinion if that's all documented I don't see why it would be coded to long term insulin use. There was no mention of an insulin brand just verbiage of sliding scale insulin. Just to offer some insight, on my job they code the mentioned verbiage and I don't agree. It further made me doubt it after being marked incorrect on study material.
 
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What if the patient is diabetic type 2 and is prescribed insulin but the patient is not taking it as prescribed. Do we still code the long term insulin use w/ the noncompliance code?
 
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susan-williams said:
What if the patient is diabetic type 2 and is prescribed insulin but the patient is not taking it as prescribed. Do we still code the long term insulin use w/ the noncompliance code?
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It still risk adjusts whether they are taking it regularly or not. They still have the need for insulin because the BS is too high. High blood sugar has many future long term complications.
 
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hyb2922crc said:
Hello, I'm seeking guidance on whether sliding scale insulin use should be coded to long term insulin use (z79.4). I have researched and have been unlucky in finding any articles that directly addresses this. If you have any information feel free to share and if possible provide rationale and resources. Thank you in advance!
Click to expand...

Sliding scale is just a dose of insulin. Your body needs different doses depending on what you eat and how many calories you consume. Insulin is usually prescribed (if DM2) because the oral meds aren't enough to lower the glucose in the blood. Each insulin manufacturer has their own sliding scale based on the glucose levels when the BS was checked.

Its different if a patient is in the hospital. Hospitals sometimes put patients on insulin to have more control over glucose levels. Once they leave the hospital, the patients are usually put back on their oral diabetic meds.

DM type 1 patients have to have insulin to live, so long-term use is not coded because its inherent in DM1.

AHA coding clinic: 4th quarter 2004-

Question 2:
Is it necessary to use code V58.67, Long-term [current] use of insulin, with type 1 diabetes? The use additional code note is only at the fifth digits for type II diabetes.
Answer:
Assign code V58.67 for type I diabetics, if desired. Type I diabetics must use insulin because their pancreas does not produce insulin naturally. Therefore, it is not necessary to assign code V58.67. Patients with type II diabetes or gestational diabetes may use insulin to control their blood sugar levels. It is necessary to assign code V58.67 for type II diabetic patients to indicate insulin use.
 
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hyb2922crc said:
Hello, I'm seeking guidance on whether sliding scale insulin use should be coded to long term insulin use (z79.4). I have researched and have been unlucky in finding any articles that directly addresses this. If you have any information feel free to share and if possible provide rationale and resources. Thank you in advance!
Click to expand...
Sliding scale insulin usage is not the same as long term insulin usage. Sliding scale insulin is commonly used in acute setting to bring down glucose level gradually in type 2 DM, once the glucose normalizes patients are transferred back to oral hypoglycemia drugs, and may not need insulin again. In cases where the patient can no longer produce insulin they are put permanently on insulin, this is long term insulin usage.
 
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