1. Coding Diabetes Mellitus
The Complete Diagnosis Coding Book by Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
Chapter 12
Coding Diabetes Mellitus
McGraw Hill/Irwin
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

2. 12 - 2
Learning Outcomes
Discern between type 1, type 2, and gestational diabetes with regard to coding.
Apply the guidelines for coding diabetic manifestations and comorbidities.
Abstract encounter notes to determine whether the diabetes is controlled.

3. 12 - 3
Learning Outcomes
Determine the correct sequencing for coding a diabetic patient’s condition.
Correctly code the use of insulin and insulin pumps.
Use guidelines properly for reporting diabetes during encounters for other diagnoses.

4. 12 - 4
Introduction
Diabetes mellitus is a very dangerous disease that affects as many as 16 million Americans. It is one of the leading causes of death by disease.
There are four types: Type 1, Type 2, Gestational, and Other.

5. Diabetes Mellitus Type 1 Diabetes: Insulin-dependent diabetes (IDDM)
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Diabetes Mellitus
Type 1 Diabetes:
Insulin-dependent diabetes (IDDM)
Juvenile diabetes
Can occur at any age
Occurs suddenly

6. Diabetes Mellitus Type 2 Diabetes:
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Diabetes Mellitus
Type 2 Diabetes:
Non-insulin-dependent diabetes (NIDDM)
Can occur at any age but most often in adults over the age of 40
Occurs gradually

7. Diabetes Mellitus Gestational Diabetes Mellitus (GDM):
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Diabetes Mellitus
Gestational Diabetes Mellitus (GDM):
Usually a temporary condition occurring during pregnancy
Can increase risk of developing diabetes later

8. Hyper/Hypoglycemia Hyperglycemia: Abnormally high glucose levels
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Hyper/Hypoglycemia
Hyperglycemia: Abnormally high glucose levels
Hypoglycemia: Abnormally low glucose levels

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Coding Diabetes
Once a patient has been diagnosed with diabetes mellitus:
All codes require FIVE digits: 250.xx
Almost always reported because diabetes is a systemic disease

10.
Coding Diabetes
Diabetes with manifestations will always require at least TWO codes:
First, the diabetes code: 250.xx
Second, the manifestation code

11. Coding Diabetes Diabetes Mellitus: Code category 250
Coding Diabetes
Diabetes Mellitus: Code category 250
Fourth Digit (250.xx) will identify the manifestation, if any.
For example:
250.0x No manifestation
250.4x Renal manifestation

12.
Coding Diabetes
Fifth Digit (250.xx) will identify the current status of the diabetes.
The specific type of diabetes: Type 1 or type 2
Does the documentation specifically state uncontrolled?

13.
Coding Sequence
Diabetes Code (250.xx): Always listed before any manifestation code
If not the reason for the encounter, list the diabetes code after the codes for the reason.

14.
Insulin Use
When a patient with type 2 diabetes uses regular insulin, code also:
+ V58.67 Long-term (current) use of insulin
Do not use this code with an individual diagnosed with type 1 diabetes.

15. Insulin Pumps Underdose due to malfunction of pump OR
Insulin Pumps
Underdose due to malfunction of pump OR
Overdose due to malfunction of pump
Add code:
Mechanical complication of other specified prosthetic device, implant, and graft, due to insulin pump

16.
Diabetes Insipidus
Diabetes Insipidus: Disorder of water metabolism; also known as pituitary diabetes insipidus

17.
Chapter Summary
Diabetes mellitus is a condition that, unfortunately, becomes an issue for more and more individuals every day.