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

2. 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

3. 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

4. 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IDDM, NIDDM, Juvenile & adult-onset are outdated terms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

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

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

7. 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.

8. 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.

9. 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?

10. 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)

11. 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.

12. 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

13. 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

14. 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

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

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

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

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

19. 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.

20. 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

21. (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

22. 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.

23. 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.

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

25. 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

26. 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

27. 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.

28. 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

29. 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