Endocrine, Nutritional and Metabolic Disease Chapter IV HS317b - Coding & Classification of Health Data

Diabetes Mellitus Often associated with long-term complications that can affect every system and part of the body. Type 1 Diabetes Mellitus (E10) Type 2 Diabetes Mellitus (E12) Other Specified Diabetes Mellitus (E13) Diabetes Mellitus in Pregnancy Impaired Glucose Tolerance

Classification of Diabetes 1. By type 2. By whether or not it is accompanied by complications affecting other body systems Microvasclar Complications Includes neuropathy, nephrophathy or vision disorders Macrovascular Complications Conditions like heart disease and stroke 3. Sixth digit….’9’ E11.909 11/20/2018

IDDM versus NIDDM Refer to physician documentation for accurate identification of the type of DM Assignment of the type of diabetes is not based on patient age or insulin requirements IDDM, NIDDM, Juvenile & adult-onset are outdated terms IDDM inappropriately used to described type 2 DM that requires insulin for control

Complications of Diabetes Fourth character of DM identifies systemic manifestation Note--cannot code the following if coding diabetes with complications: E11.909 Type 2 diabetes mellitus without (mention of) complication E10.909 Type 1 diabetes mellitus without (mention of) complication

Chronic Complications of Diabetes Diabetic neuropathy Diabetic retinopathy Diabetic cataracts Diabetic nephropathy Diabetes with circulatory complications Diabetic arthropathy Diabetic foot

Dagger †/Asterisk * Standard Dual Combination for circumstances when there are two codes for diagnostic statements containing information about both an underlying generalized disease and a manifestation in a particular organ or site which is a clinical problem in its own right. † code marks the primary code for the underlying disease * code marks the manifestation code.

Diagnosis Type 6 – Proxy MRDx It is assigned to a designated asterisk code in a dagger/asterisk relationship when the condition it represents fulfils the requirements stated in the definition of Most Responsible Diagnosis. Only one asterisk code with Dx type 6 is allowed per encounter.

Issues in coding When do you assume there is a causal relationship if the chart documentation does not make this connection? How do you code diabetes with multiple complications and only one of the complications is being treated in the current admission?

Peripheral vascular disease & Chronic renal failure & DM Common complication of diabetes CIHI recommends that when either of these two conditions coexist with diabetes it is possible to assign them to the “with complication” categories in E10-E14 PVD & CRF & DM (relationship Q639 & Q1163)

45-year old male with known longstanding type 1 DM presents for hemodialysis due to progression of diabetic nephropathy. Patient is now in end-stage renal disease stage and will require hemodialysis on a continuous basis.

Code E10.229† Type 1 Diabetes mellitus with end-stage renal disease [ESRD] N08.3* Glomerular disorders in DM N18.8 End stage renal disease

Code (Dx type M) E10.229† Type 1 Diabetes mellitus with end-stage renal disease [ESRD] (Dx type 6) N08.3* Glomerular disorders in DM (Dx type 3) N18.8 End stage renal disease

Multiple Complications Patient comes in with Type 1 diabetic nephropathy, diabetic neuropathy, diabetic retinopathy and diabetic gastroparesis. The diabetic nephropathy was the only condition treated. Query 907 & Query 1044

E10.2~9† - type 1 DM with renal complications N08.3* Glomerular disorders in diabetes mellitus E10.789 † Diabetes mellitus with other specified multiple complications G59.0*, H36.0*, K31.8

(M) E10.2~9† - type 1 DM with renal complications (6) N08.3* Glomerular disorders in diabetes mellitus (3) E10.789 † Type 3 Diabetes mellitus with other specified multiple complications (all 3’s) G59.0*, H36.0*, K31.8

Hypoglycemia An insulin dependent diabetic is admitted with hypoglycemia (no coma). Patient required insulin adjustment. How would you code this?

Hypoglycemia (M) E14.639 Unspecified diabetes mellitus with hypoglycemia Would you include E16.1 Other hypoglycemia

Hypoglycemia in DM Select code E1~.63 for hypoglycemia in the diabetic patient. Codes E16.0-E16.2 (hypoglycemia other, unspecified or drug induced) are mutually exclusive and must not appear on the same abstract to record hypoglycemia.

Hypertension & Associated Conditions This type 2 diabetic renal patient, adequately controlled with diet/oral agents was admitted. Patient has hypertension for which medication is utilized. Patient is also receiving hemodialysis three times a week. Query 8769

(M) E11.229† Type 2 diabetes mellitus with end-stage renal disease [ESRD] (3) N08.3* Glomerular disorders in diabetes mellitus (3) N18.9 Chronic renal failure, unspecified (3) I12 Hypertensive renal disease

Hypertension renal disease I12 is assigned to cases where hypertension is present with chronic renal failure, unspecified renal failure, unspecified contracted kidney, arteriosclerotic nephritis, nephropathy & nephrosclerosis. Not acute renal failure A causal relationship is presumed and does not have to be so stated by the physician.

Patient is coming into hospital because of gangrenous toes that require amputation. Patient is a type 2 diabetic, insulin dependent. Fasting glucose is within normal limits.

(M) E11.519 Type 2 diabetes mellitus with peripheral angiopathy with gangrene (6) I70.2 Diabetic (atherosclerotic) gangrene

Principle for Coding Diabetes If selecting E10.9~, E11.9~, E13.9~ or E14.9~ do not assign any other code from the range E10-E14 Multiple diagnosis codes may be used †/* Dagger and asterisk used to designate the etiology code and the manifestation code respectively, for terms subject to dual classification. Use Diagnosis Type 6 if appropriate

Dehydration Code it Gastroenteritis and Dehydration If there is no underlying cause. If electrolyte imbalance is severe enough to warrant rehydration with intravenous fluids. Gastroenteritis and Dehydration K52.9 (M) Gastroenteritis E86.0 (1) Dehydration

Rule for GI & Dehydration If coding any of the following diagnosis K52.0-K52.9, A02.0, A05.9, A08.0, and A09, J10.8, J11.8, A18.3 with K93.0 Dehydration must be sequenced second as a diagnosis type 1 if rehydration is instituted or diagnosis type 3 if only oral intake of fluids and monitoring.

Classification based on MRDx MCC 10 Endocrine, Nutritional and Metabolic Diseases and Disorders Crossover of CMG to other MCC categories Diagnosis requiring amputation of lower limb except toe—if major vascular surgery CMG 881 Amputation of lower limb except toe Obesity procedures CMG 478 High Gastric bypass Intestinal anastomosis NOS

Medical Partition Diabetes – CMG 483 Cystic Fibrosis – CMG 487 Inborn Errors of Metabolism – CMG 488 MRDx of Disturbed Amino-Acid Transport, Renal Glycosuria, Other Disorder Carbohydrate Trans/Met, Metabolism disorder Dehydration – CMG 485 Nutritional & Miscellaneous Metabolic Disorders