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Revisit the revised diabetes code definitions

HIM Connection, April 19, 2005

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The code range 250.00 to 250.93 has been revised to further define the difference between type I (1) and type II (2) diabetes, resulting in 40 revised titles. The designations "IDDM" (insulin dependent diabetes mellitus) and "NIDDM" (non-insulin dependent diabetes mellitus) have led to considerable confusion in determining whether a patient has "juvenile-onset" or "adult-onset" diabetes.

The American Diabetes Association redefined classifications of diabetes in 1997 and medical textbooks have used the new definitions since 2001. The revised titles are based on the following instructions:

• Eliminate the terms "insulin dependent diabetes mellitus" and "non-insulin dependent diabetes mellitus" in favor of "type 1" and "type 2", but use Arabic rather than Roman numerals to avoid confusion.
• Type 1 diabetes is characterized by beta cell destruction, usually leading to absolute insulin deficiency.
• Type 2 diabetes is defined as a term for individuals who have insulin resistance and usually have relative (rather than absolute) insulin deficiency.
• A new stage of impaired glucose homeostasis called "impaired fasting glucose" has been defined as a fasting plasma glucose of >110 mg/dl but <200 mg/dl. The stage called "impaired glucose tolerance" is retained, defined as an oral glucose tolerance test value of >140 mg/dl but <200 mg/dl.
• No change is recommended to the current diagnostic criteria for gestational diabetes; however, selective screening, rather than universal screening, for glucose intolerance in pregnancy is now recommended.

Clinical documentation specificity is critical in order to assign the correct code. The members of the Department of Endocrinology at your facility or practice should encourage the rest of the medical staff to document these citations correctly.

The National Centers for Health Statistics state there is no room in ICD-9 for a conversion of the designation of diabetes to type 1 or type 2 and that it will remain the same (Roman numerals) until ICD-10 is in place, although the terms IDDM and NIDDM are discouraged.

This excerpt is adapted from The 2005 ICD-9-CM Training Kit .

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