ICD-9-CM vs. ICD-10-CM: Examine the differences in diabetes codingInfuced to receive articles like this one in your inbox? Subscribe equipoise weekly dosage JustCoding News: Leppert, CPC-A, at mleppert hcpro. Join HCPro for a minute webcast with step-by-step strategies and tips to reduce denials along with advice to improve Our experts explain what CMS actually says about charging for services in addition to the room rate and provide strategies
ICDCM Diagnosis Code E Drug or chemical induced diabetes mellitus with hyperglycemia
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Examine the differences in diabetes coding JustCoding News: Outpatient , July 25, Want to receive articles like this one in your inbox?
Most coders can quickly come up with Consider these two patients. Patient A is a type 2 diabetic with well controlled diabetes. Patient B is a type 2 diabetic with uncontrolled diabetes who also suffers from diabetes-related chronic kidney disease. The physician loses reimbursement on Patient B, who is sicker and requires more care, Young says. When it comes to the code assignment for diabetes mellitus in ICDCM code series , coders identify whether the diabetes is type 1or 2 using a fifth digit, says Shannon E.
If the diabetes is secondary, coders choose from codes in the series. All of those codes require a fifth digit to indicate whether the diabetes is controlled or uncontrolled, type 1or type 2.
The fifth digit subclassifications are:. Coders also need to note that codes For example, if the physician documents type 2 diabetic with uncontrolled diabetes with moderate diabetes-related chronic kidney disease, coders would report two codes:. As a result, providers must document additional information, such as any underlying condition that caused the diabetes or whether drugs induced the diabetes.
For example, a patient may have diabetes due to a condition or a drug the patient is taking. The fourth character identifies the presence of manifestations or complications. The fifth and sixth characters identify specific types of manifestation. Consider the patient who has type 2 uncontrolled diabetes with moderate diabetes-related chronic kidney disease. A note under the code for type 2 diabetes mellitus with diabetic chronic kidney disease instructs coders to use an additional code to identify the stage of chronic kidney disease N She recommends changing the query forms now to get physicians used to the additional information they will need to document for ICDCM.
For secondary diabetes, the documentation of the specific type of secondary diabetes will be increasingly important so that coders assign the correct category of codes, McCall says.
One striking difference in coding for diabetes in ICDCM centers on the concept of controlled or uncontrolled diabetes, McCall says. However, if coders reference diabetes mellitus in the ICDCM alphabetic index, they will find that the concept of controlled or uncontrolled is coded in a different way.
If coders look up the terms they commonly use, such as inadequately controlled, poorly controlled, or out of control, they will find an instruction telling them to code to the type of diabetes—type I, type 2, due to an underlying condition, due to a drug—with hyperglycemia. Oddly, though, ICDCM does not include uncontrolled as a modifying term, even though that is what coders have badgered physicians to report for years, she adds.
Coders need to code the T code first, then the diabetes code. For example, a physician documents an initial encounter with a patient who has corticosteroid-induced diabetes mellitus without complications.
The diabetes is coded as an adverse effect of a corticosteroid, McCall says. This could have some impact for inpatient coders. Traditionally when a patient is admitted for secondary diabetes, coders report the secondary diabetes code first, as the principle reason for the admission. When it comes to looking at the guidelines, coders need to be aware of an instructional note that McCall sees as somewhat contradictory.
The ICDCM guidelines instruct coders to report first for the T code for use of steroids when patients are taking appropriately but suffer an adverse event.
When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug T36—T That seems to contradict the guideline to code the T code first instead of the diabetes code, McCall says. A physician diagnoses a patient with severe nonproliferative diabetic retinopathy with macular edema due to insulin-dependent type 2 diabetes mellitus.
Although this example may look like coders will need several codes, in ICDCM, they actually need only one code to identify the diabetes and the manifestation of severe nonproliferative diabetic retinopathy, McCall says. Coding inside and outside of the package Complications from immobility by body system E-mailed Joint Commission creates new Sentinel Event Alert for violence against healthcare workers Injections and infusions continue to confuse coders CMS and Joint Commission clarify door-closing devices standards Differentiate between types of wound debridement Joint Commission and CMS Alignment: Coding inside and outside of the package Report codes , for gastrointestinal endoscopy The Hospital Guide to Contemporary Utilization Review Searched inpatient peer review separate encounter standard for delinquency rate for hospitals acdis Coding boot camp what should be combined CTA documentation wound vac cdi.