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Conquer complex ICD-9 coding: Diabetes mellitus

HIM Connection, May 24, 2005

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After more than a quarter-century of training coders, Deborah Grider, CMA, CPC, CPC-H, CCS-P, CCP, CEO and president of consulting firm Medical Professionals, Inc., based in Indianapolis, knows which ICD-9-CM codes cause the most confusion and noncompliance.

We highlight diabetes mellitus (DM) this week.

Code descriptor changes in the official guidelines eliminated improper categorization of diabetes based on whether the patient is insulin- or noninsulin-dependent (IDDM/NIDDM) or based on the age of onset of the disease. "When coding diabetes, the patient's status as IDDM or NIDDM is not a determining factor in establishing whether the patient is Type I or Type II," she says. Rather, the level of function of the beta cells in the pancreas determines the type of diabetes.

For ICD-9 250, the fifth-digit subclassification descriptions have changed, and it's wise to become familiar with them now. "When ICD-10 emerges, there will be seven digits of specificity for DM," she points out. There is a new note for use of V58.67. Assign this code only if the patient requires long-time use of insulin and has NIDDM. "The assumption is that Type I patients must be maintained on insulin, so the use of this V code for them would be redundant," she says.

Because diabetes is an underlying systemic disease, code for it if the physician documents its presence, even in the absence of documented active intervention for diabetes itself during the patient encounter. The release of new official guidelines does not change guidelines for coding DM, Grider says. "The code selection is based on the physician's documentation of Type I or Type II, manifestations of the disease, and whether the current treatment regimen keeps the glucose levels within acceptable levels [controlled v. uncontrolled]."

The official guidelines do introduce a new note for use of 250.6, diabetes with neurological manifestations, such as gastroparalysis (536.3) or gastroparesis (536.3). Code the underlying condition first followed by the manifestation.

Editor's note: Stay tuned, next week HIM Connection will highlight neoplasm coding compliance concerns.

This excerpt is adapted from Briefings on Coding Compliance Strategies.

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