Coding corner update: Keep these coding tips in mind for diabetes

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. In the next several issues of The Record, you’ll find a series of revised “Coding corner” articles that include updated codes to align with the transition to ICD-10-CM.

Diabetes is one of the most common and costly conditions in the U.S. This complex disease causes long-term complications affecting the renal, nervous and peripheral vascular systems, as well as the feet and eyes. According to 2012 Centers for Disease Control and Prevention statistics, diabetes continues to be the leading cause of kidney failure, nontraumatic lower-extremity amputations and blindness among adults age 20 to 74.

It’s no surprise that documentation and coding for this complicated condition is a challenge to both providers and coders. Here are some tips to help improve medical record documentation for diabetes.

Common documentation and coding challenges for diabetes mellitus:

• Documentation in the medical record does not support a link between diabetes and its associated complications.

• Documentation supporting a specific diabetic complication is present, but the proper codes are not reported.

• Electronic medical record search engines may provide long lists of codes for diabetes, making selection of the most specific diagnosis code a challenge.

• Electronic billing systems limit number of diagnoses for patients with multiple diabetes complications and chronic conditions.

Coding of diabetes in ICD-10-CM has changed significantly. There are several pieces of information which must be documented to aid in selection of the correct code:

• E08 — Due to underlying condition
• E09 — Drug or chemical induced
• E10 — Type 1
• E11 — Type 2
• E13 — Other specified diabetes mellitus

The complications are then listed consistently:

DM = diabetes mellitus

Fifth and sixth characters are used for some categories to provide additional specificity regarding the complication. Example: E10.351 Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema.

Additional coding tips

• Document if the diabetes is Type 1 or Type 2 every time you treat the patient. Documentation of insulin usage alone does not support a diagnosis of Type 1 diabetes. If the type of diabetes is not documented, then use the unspecified code, Type 2.

• ICD-10 does not include the terminology of controlled or uncontrolled. If appropriate, use the codes for hypoglycemia or hyperglycemia with fourth and fifth characters of “64” and “65.”

• Assign code Z79.4, long-term (current) use of insulin for patients that use insulin to control their diabetes. This code shouldn’t be assigned if insulin is only given temporarily to bring a patient’s blood sugar under control during an encounter.

• Assign a code from category E08, DM due to underlying condition, when diabetes is caused by another condition or event such as cystic fibrosis, malignant neoplasm of the pancreas or pancreatectomy. Code first the underlying condition.

• Report a code from category E09, drug or chemical-induced DM, when the diabetes is due to a drug or toxin poisoning. Also include a code for adverse effects, if applicable to identify the drug.
• Assign a code from category O24.4 for gestational diabetes and report a code from categories O24.0 to O24.3 for obstetric patients with pre-existing diabetes. Additional codes from the E10 to E11 categories should be assigned to indicate the type of diabetes.

• Many patients will have complications in more than one subcategory. Assign as many subcategory codes as needed to communicate the complexity of a patient’s condition.

• Report a code from category T38.3X for an underdosing or overdose of insulin for any reason. Next report appropriate codes from categories E08 to E13.

• Use concise words and abbreviations in search engines for electronic medical records for help in coding diabetes to the highest specificity. For example, searching for “dm with renal” or “retinopathy due to dm” instead of “diabetes mellitus” could yield a shorter and more specific list of code choices.

ICD-10-CM coding for all conditions should follow coding conventions, chapter specific guidelines and general coding guidelines.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.