Coding corner update: Keep these coding tips in mind for complications related to 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.

Detailed and concise medical record documentation is important in order to select the correct codes for renal, ophthalmic, neurological and peripheral circulatory complications of diabetes.

Selection of diabetic complication codes
A common coding error for diabetes is the selection of the wrong complication code. In some cases, the code reported when the condition is a complication of diabetes isn’t the same code that’s reported when the condition exists independently.

This is an easy distinction for a coder to make by referencing the index or tabular sections of ICD-10-CM code books. But providers who select their own codes through search engines in an electronic medical record may often select the wrong code for the complication.

For example, idiopathic progressive neuropathy is coded as G60.3 if it’s the patient’s primary condition. However, if the patient has neuropathy due to diabetes, it’s coded to the diabetes codes in the E08 to E13 range with a fourth character of “4” (neurological complications in diabetes).

Tips for diabetes with renal complications — E08 to E13 with a fourth character of “2”

• With ICD-10-CM, the only diabetic nephrology complication that requires an additional code is CKD (N18.1 to N18.6). The specific stage of the disease must be stated in the documentation. CKD stages cannot be coded based on the glomerular filtration rate.

• Patients who have both diabetes and hypertension may develop CKD as a result. In this case, three codes are required. One code for diabetes with renal complication (E08.22, E09.22, E10.22, E11.22, E13.22); a second code from category I12 (or I13) with a fourth character of “0” or “9”; and a third code from category N18 to indicate the specific stage of the chronic kidney disease.

• If documentation indicates both a stage of CKD and end-stage renal disease, report code N18.6 only.
  

Tips for diabetes with ophthalmic complications — E08 to E13 with a fourth character of “3”

DM = diabetes mellitus

• Don’t confuse a diabetic cataract with a senile cataract. Diabetic cataracts or “snowflake cataracts” are rare and occur only in diabetes. Although a senile cataract might occur earlier and more frequently in diabetes, it’s not classified as a complication of diabetes.

Tips for diabetes with neurological complications — E08 to E13 with a fourth character of “4”

• Documentation specifying “diabetic peripheral neuropathy” or “loss of protective sensation” due to diabetes should be assigned to polyneuropathy (codes E08 to E13 with “42” as the last two characters). This is the most common form of diabetic neuropathy, affecting the feet, legs and sometimes the hands and arms.

• Autonomic neuropathy affects the autonomic nervous system, which controls the heart, bladder, lungs, stomach, intestines, sex organs and eyes. Many conditions are attributed to autonomic neuropathy and should be reported with codes from E08 to E13 with “43” as the last two characters. No additional code is required to identify the specific complication.

• Report E08 to E13 with “44” as the last two characters for diabetic amyotrophy, also known as radiculoplexus neuropathy, femoral neuropathy or proximal neuropathy. This condition affects nerves in the thighs, hips, buttocks or legs.

• Report the appropriate code from E08 to E13 with “41” as the last two characters for diabetic mononeuropathy, also known as focal neuropathy. This condition involves damage to a specific nerve in the face, torso or leg. It can also occur when a nerve is compressed, like in the case of carpal tunnel syndrome.

Tips for diabetes with peripheral circulatory disorders — E08 to E13 with a fourth character of “5”

Tips for diabetes with other specified complications — E08 to E13 with a fourth character of “6”

• Diabetic hypoglycemia or hypoglycemic shock is reported with E08.6 to E13.6 with last two characters of “41” or “49” to identify with or without coma.

• Code E08.6 to E13.6 with last two characters of “21” or “22” for diabetic skin ulcers, depending on location. Report an additional code to identify the specific location of the ulcer from the L97 and L98 range of codes.

• Code E08.6 to E13.6 with last two characters of “10” for diabetic neuropathic arthropathy (Charcot’s joint), which occurs when a joint deteriorates because of nerve damage, usually in the ankle or foot.

Other tips for diabetes and ulcers

• If the ulcer is caused by a superimposed infection, it shouldn’t be coded as a complication of diabetes. Not all ulcers in diabetic patients are related to the condition.

• Pressure ulcers, ICD-10 category L89, also known as decubitus ulcers, shouldn’t be coded as a complication of diabetes.

• For ulcers caused by diabetic neuropathy, report the appropriate diabetic complication code, followed by a code from categories L97 and L98 for the location of the ulcer. If gangrene is present, also code diabetic peripheral angiopathy with gangrene, E08 to E13 with last two characters of “52.”

ICD-10 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.