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

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. 12 - 2

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. 12 - 3

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. 12 - 4

5. Diabetes Mellitus ·Type 1 Diabetes: ·Insulin-dependent diabetes (IDDM) ·Juvenile diabetes ·Can occur at any age ·Occurs suddenly 12 - 5

6. 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 12 - 6

7. Diabetes Mellitus ·Gestational Diabetes Mellitus (GDM): ·Usually a temporary condition occurring during pregnancy ·Can increase risk of developing diabetes later 12 - 7

8. Hyper/Hypoglycemia ·Hyperglycemia: Abnormally high glucose levels ·Hypoglycemia: Abnormally low glucose levels 12 - 8

9. 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 12 - 9

10. Coding Diabetes Diabetes with manifestations will always require at least TWO codes: ·First, the diabetes code: 250.xx ·Second, the manifestation code 12 - 10

11. 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 - 11

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? 12 - 12

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. 12 - 13

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. 12 - 14

15. Insulin Pumps ·Underdose due to malfunction of pump OR ·Overdose due to malfunction of pump ·Add code: 996.57 Mechanical complication of other specified prosthetic device, implant, and graft, due to insulin pump 12 - 15

16. Diabetes Insipidus ·Diabetes Insipidus: Disorder of water metabolism; also known as pituitary diabetes insipidus 12 - 16

17. Chapter Summary ·Diabetes mellitus is a condition that, unfortunately, becomes an issue for more and more individuals every day. 12 - 17