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Coding for Diabetes Mellitus

Coding for Diabetes Mellitus. Presented by: Total Health Care Totally There For You. Objective. Gain an understanding of billing ICD-9-CM codes, specific to Diabetes Mellitus. ICD-9-Cm and ICD-10-CM. This presentation will focus on ICD-9-CM codes ICD-10-CM will be effective 10/1/2015.

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Coding for Diabetes Mellitus

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  1. Coding for Diabetes Mellitus Presented by: Total Health Care Totally There For You Totally There For You

  2. Objective • Gain an understanding of billing ICD-9-CM codes, specific to Diabetes Mellitus Totally There For You

  3. ICD-9-Cm and ICD-10-CM • This presentation will focus on ICD-9-CM codes • ICD-10-CM will be effective 10/1/2015 Totally There For You

  4. Documentation and ICD-9-CM Coding • Coders/health care providers can assign ICD-9-CM codes based on what is documented in the chart Totally There For You

  5. Three Code Ranges for DM • 250.00-250.93: Most common. 40 codes in this range. Requires 5 digits. • 249.0X-249.9x: DM due to secondary cause • 648.XX: Gestational DM Totally There For You

  6. 250.XX Series. Base code and 4th digit Will be the focus of education 250 represents DM 250.X - The 4th space indicates the complication or not. 250.1 is Diabetes with Ketoacidosis; 250.0 means DM without mention of complication Totally There For You

  7. 250.XX 5th digit • The subclassifications are as follows: • 0 -type 2 or unspecified, not stated as uncontrolled • 1-type 1, not stated as uncontrolled • 2-type 2 or unspecified, uncontrolled • 3-type 1, uncontrolled • 250.XX – The 5th digit indicates the type (1 or 2) and whether it is controlled or uncontrolled. 250.10 – Diabetes with Ketoacidosis, type 2 or unspecified, not stated as uncontrolled; 250.01 – DM w/o mention of complication, type 1, not stated as uncontrolled; 250.53- DM with ophthalmic manifestations, type 1, uncontrolled Totally There For You

  8. Additional coding rules for DM • If the type of DM is not documented in the medical record, the default is type 2 • All type 1 pts. use insulin, so therefore there is no need to code the long term insulin use, it is assumed they are on the medication • Some patients use insulin for type 2 as well. If the documentation does not indicate the type of DM but does indicate insulin use, the appropriate 5th digit for type 2 must be used • Routine (long term) insulin use is coded using V58.67 in addition to the 250.XX code, when appropriate, for type 2 or non-indicated type of DM Totally There For You

  9. Sequencing DM Codes • When assigning codes for DM and its associated conditions • 250.XX is sequenced first • The associated conditions are coded second • Example: Practitioner documents the illness as DM, on insulin, with CKD, stage 3 secondary to DM. Codes as follows: • 250.40-DM with renal manifestations, type 2 or not specified, not stated as uncontrolled • 585.3-CKD stage 3 • V58.67 – long term use of insulin* * Long tem insulin coded in this instance because note does not indicate type of DM, so coding rules assume type 2 Totally There For You

  10. Practice Coding • Note lists assessment as DM, type 1, uncontrolled, taking insulin regularly • 250.03 –DM w/o mention of complication, type 1 uncontrolled No V code for long term insulin use as it is assumed type 1 DM patients take insulin Assessment indicates DM, uncontrolled with gangrene L great toe. Continues to take Novalog as ordered. • 250.72-DM with peripheral circulatory disorders, type unspecified, uncontrolled • 785.4-Gangrene • V58.67 – Long term insulin use Totally There For You

  11. Practice coding continued • Observation says: A1C’s running between 10 and 11.4; Blood sugar log reviewed. Taking insulin as prescribed. • Assessment: DM, type 1. Codes to: 250.01 DM, type 1, not stated as uncontrolled* *Not able to code to uncontrolled as assessment did not indicate an uncontrolled illness Totally There For You

  12. More Practice Coding • Assessment indicates DM, uncontrolled • Code to 250.02 - DM, unspecified type, uncontrolled • Assessment indicates Diabetes Mellitus • Codes to 250.00 – DM w/o mention of complication, type not specified, not stated as uncontrolled Totally There For You

  13. Insulin Pump malfunctions • Underdose of insulin due to pump failure is assigned 966.57-mechanical complication due to insulin pump and is listed FIRST followed by the appropriate DM code, based on the documentation • Overdose of insulin is also reported using the same code 966.57 first, then 962.3 poisoning by insulins and antidiabetic agents, followed by the appropriate DM code, based on the documentation Totally There For You

  14. A peEk into ICD-10-CM DM Codes • E08-E13 Range • E08- due to underlying condition • E09- drug or chemical induced • E10 –Type 1 • E11- Type 2 • There is no E12 • E13 – other specified DM Totally There For You

  15. More ICD-10-CM Information • If type of DM is not documented- code default is E11 • If type not indicated but insulin use is documented, default remains E11 with additional code of Z79.4 (long term insulin use) • The complication/comorbid condition is in the code for ICD-10-CM • Suggest practicing specific documentation of DM, Type and Complication if relevant Totally There For You

  16. Summary • Coding is based on the documentation in the note • Coding will be as accurate as the assessment documented • Be specific with your documentation • Long term insulin use does not need to be reported when documentation indicates a type 1 diabetic Totally There For You

  17. Questions? Totally There For You

  18. Thank You Michelle Solomon Data Analytics and Provider Education Manager Total Health Care, Inc. 3011 W Grand Blvd, Suite 1600 Detroit, MI  48202 Office:  313-871-6587 Cell: 313 300-2852 Fax: 586-461-2538 msolomon@thcmi.com Totally There For You

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