Health Information Management

Tip of the week: Understand new code category for secondary diabetes

HIM Connection, July 8, 2008

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One of the most important ICD-9 code changes that will take effect October 1 is the addition of a new category of codes for secondary diabetes—a condition that accounts for 1–5% of all diabetes cases. Secondary diabetes codes will fall under the 249 code range and will include a fourth digit to identify the absence or presence of a complication or manifestation and a fifth digit to specify whether the diabetes is uncontrolled, not stated as controlled, or unspecified. For example, code 249.30 will denote secondary diabetes mellitus with other coma, not stated as controlled, or unspecified. Code 249.31 will denote secondary diabetes mellitus with other coma, uncontrolled.
 
Coders should familiarize themselves with the causes of secondary diabetes by visiting the American Diabetes Association Web site at http://care.diabetesjournals.org/misc/terms.shtml and then searching for volume 30, pages S42–S47, year 2007. When a physician documents a condition from the list of causes published by the American Diabetes Association that could be the cause of secondary diabetes, coders should try to identify a possible relationship between that condition and the secondary diabetes. Coders should not automatically assign a code from the 250.xx category.
 
For example, when a patient has diabetes documented as well as Rabson-Mendenhall syndrome (a genetic defect in insulin action), pancreatic adenocarcinoma (a disease of the exocrine pancreas), or congenital rubella (an infection), the patient may have secondary diabetes, in which case the coder should consider a code from the 249.xx category. When in doubt, coders should always query the physician for further clarification.
 
Editor’s note: This tip was adapted from the July 2 issue of JustCoding.com. For more information, visit www.justcoding.com.



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