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December 10 , 2007

Coding for Secondary Diabetes Mellitus
For The Record
Vol. 19 No. 25 P. 30

Secondary diabetes mellitus is a type of diabetes caused by something other than genetics or environmental factors. It is characterized by elevated blood sugar levels that develop as the result of another medical condition. It may also develop when the pancreatic tissue responsible for the production of insulin is absent because it is destroyed by a disease.

Secondary diabetes mellitus may be temporary but can become chronic depending on the underlying cause. The following are possible causes of secondary diabetes mellitus:

• disorders that disrupt pancreatic function, such as hemochromatosis (excessive absorption of iron; 275.0), chronic pancreatitis (577.1), cystic fibrosis (277.0x), and pancreatic trauma;

• surgical removal of the pancreas;

• endocrine disorders such as acromegaly (253.0), hyperthyroidism (category 242), and Cushing’s syndrome (255.0);

• liver diseases such as fatty liver disease (571.8) and hepatitis C (070.70);

• autoimmune diseases such as celiac disease (579.0);

• certain medications, such as diuretics, beta blockers, glucocorticoids, anabolic steroids, and antiretrovirals; and

• opiates and alcohol.

Secondary diabetes mellitus is assigned to ICD-9-CM code 251.8, Other specified disorders of pancreatic internal secretion. Code 251.8 is sequenced as a secondary diagnosis with the code for the underlying cause sequenced first. However, if the secondary diabetes is drug induced, the code assignment will depend on the circumstances. If the drug was taken as prescribed, it is considered an adverse effect and the manifestation will be sequenced first, which is 251.8 in this case. If it was the wrong drug improperly given or taken or it was an accidental overdose, it is considered a poisoning and the poisoning code will be sequenced first followed by code 251.8. For example, steroid-induced diabetes due to an adverse effect is classified to codes 251.8 and E932.0. Steroid-induced diabetes due to a poisoning is classified to codes 962.0 and E858.0.

Postpancreatectomy diabetes mellitus, which is the lack of insulin due to the surgical removal of all or part of the pancreas, is assigned to code 251.3, Postsurgical hypoinsulinemia, instead of code 251.8 (AHA Coding Clinic for ICD-9-CM, 1991, third quarter, page 6).

Because secondary diabetes mellitus is different than type 1 or 2 diabetes, codes from category 250 are not used for secondary diabetes mellitus. Even if the patient has diabetic manifestations related to the secondary diabetes mellitus, it is not appropriate to assign codes from category 250 when the patient is diagnosed with secondary diabetes mellitus (AHA Coding Clinic for ICD-9-CM, 1998, second quarter, page 15).

Signs and Symptoms
Signs and symptoms of secondary diabetes mellitus include polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (extreme hunger), unexplained weight loss, increased fatigue, slow-healing sores, numbness or tingling in the hands and feet, blurred eyesight or other vision changes, and frequent infections such as gingivitis, thrush, yeast infections. and urinary tract infections.

Diagnosis
Physicians diagnose secondary diabetes in the same manner as a type 1 or 2 diabetes diagnosis. The following blood tests may be performed to confirm the diabetes diagnosis:

• random plasma glucose test;

• fasting blood glucose test; or

• oral glucose tolerance test.

After the diabetes diagnosis is confirmed, the physician may choose to order additional tests to identify the underlying cause such as the following:

• pancreatic enzyme tests to diagnose pancreatitis;

• genetic tests for mutations to the genes involved in insulin production;

• thyroid blood tests to diagnosis hyperthyroidism; or

• C peptide test to assess levels of insulin in the blood.

Treatment
Treatment of secondary diabetes mellitus involves treating the underlying condition, if known. If the underlying condition can be treated, the insulin production may improve or completely return to normal. However, if the underlying condition is not known or cannot be treated, then the diabetes itself will need to be treated.

Coding and sequencing for secondary diabetes mellitus are dependent on 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 Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.

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