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For other articles and previous issues click here. May 17, 2004 Coding for
Diabetes Mellitus Diabetes mellitus is assigned to ICD-9-CM category 250. Fourth and fifth digits are needed to complete the code. The fourth digit identifies any condition or manifestation associated with diabetes. The fifth digit refers to type 1 or type 2 diabetes and whether the diabetes is controlled or uncontrolled. Type of Diabetes If the physician documents IDDM (insulin-dependent diabetes mellitus) and the type of diabetes is not included anywhere in the medical record, code 250.x1 may be assigned without further clarification from the physician. If, however, the medical record contains conflicting information (eg, type 2 insulin-dependent diabetes), code 250.x0 must be assigned. Documentation of the type of diabetes takes precedence over IDDM. The physician should be informed that the documentation needed is type 1 or type 2 diabetes instead of IDDM or NIDDM (non–insulin-dependent diabetes mellitus). Controlled vs. Uncontrolled If the physician documents poorly controlled diabetes, query the physician as to whether or not he is stating that the patient’s diabetes is uncontrolled. It cannot be assumed that poorly controlled diabetes means uncontrolled for this admission without additional documentation from the physician (AHA Coding Clinic for ICD-9-CM, 2002, second quarter, page 13). Diabetic Manifestations There must be a cause-and-effect relationship between the diabetes and the condition before it can be coded as a diabetic condition. The fact that the patient has diabetes and another condition does not necessitate coding it as a diabetic condition. For example, a diabetic patient is admitted with a foot ulcer. The foot ulcer cannot be coded as a diabetic complication unless the physician documents that the foot ulcer is due to diabetes or it is a diabetic foot ulcer. Without further clarification from the physician, code 707.15 would be sequenced as the principal diagnosis followed by code 250.0x. Gangrene and osteomyelitis are the exceptions to the cause-and-effect relationship rule. In the ICD-9-CM alphabetic index under the key word diabetes, there is a subterm with. Gangrene and osteomyelitis are two of the terms listed under this subterm. Therefore, the fact that the patient has the two conditions at the same time (eg, diabetes and gangrene) is enough to assign the diabetic complication code if there are no other stated causes of the gangrene or osteomyelitis. The physician does not have to link the gangrene or osteomyelitis to the diabetes before the diabetic code can be assigned. ICD-9-CM directives take precedence over the advice published in AHA Coding Clinic for ICD-9-CM. However, if the physician documents the osteomyelitis or gangrene is due to another cause other than diabetes, then it will not be coded as a diabetic complication. A patient may have diabetic complications in more than one system. Assign as many codes from category 250 as needed to fully describe the patient’s condition. (AHA Coding Clinic for ICD-9-CM, 1991, third quarter, page 8.) Sequence the diabetic condition that necessitated the admission as the principal diagnosis. If treatment was directed toward all conditions equally, any diabetic condition may be sequenced as the principal diagnosis. Coding and sequencing for diabetes mellitus are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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