1. Diabetes Diagnosis Coding: Common Combination Code Mistakes

2. What will we discuss??? Diabetes Guideline
Difference between Type 1 diabetes vs. Type 2 diabetes and their code sets
Diabetes diagnosis combination codes: THE BIG THREE
Types of Diabetic neuropathies
Diabetic Chronic Kidney Disease (CKD) and Hypertensive Diabetic CKD
Diabetic Eye Conditions

3. Diagnosis Coding for Diabetes
ICD-9 guideline:
*Previous train of thought for ICD-9 dictated that the physician MUST make a causal link between diagnosis such as diabetes and polyneuropathy
Using statements such as “diabetic polyneuropathy” or “polyneuropathy caused by/due to diabetes”
ICD-10 guideline:
*New train of thought completely opposite
Coders had to “relearn” the way we review documentation and make diagnosis connections
The physician now just needs to document the existing conditions.. if that condition is found under an indentation “with” for another condition in the index.. There is an assumed relationship

4. Diagnosis Coding for Diabetes
Guideline I.A.15

5. Let’s Dive In…What is Diabetes??

6. Type 1 versus Type 2
Type 1 Diabetes

7. Type 1 versus Type 2
Type 2 Diabetes

8. Coding Signs and Symptoms Guideline I.B.4
Codes that describe symptoms and signs, as opposed to diagnosis, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. Chapter 18 of ICD-10-CM, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (codes R00.0-R99) contains many, but not all, codes for symptoms.

9. Diagnosis Coding for Diabetes
Diabetes affects different body systems. Combination diagnosis codes were created to link the disease to the condition(s) it causes

10. Diagnosis Coding for Diabetes Neuropathy

11. Know Your Neuropathy
Peripheral neuropathy (also called diabetic nerve pain or distal polyneuropathy)
Proximal neuropathy (also called diabetic amyotrophy)
Autonomic neuropathy
Focal Neuropathy (also called mononeuropathy)

12. Know Your Neuropathy (Peripheral Neuropathy)
Peripheral neuropathy is the most common form of neuropathy caused by diabetes. It affects nerves leading to your extremities—to your feet, legs, hands, and arms. The nerves going to your feet are the longest in your body: after they branch of the spinal cord in the lumbar region (low back), they have to go all the way down your legs and into the feet—quite a distance.
Because the nerves leading to your feet are so long, it’s most often these nerves that are damaged; there’s more of them to be damaged. This nerve damage can lead to the foot problems often associated with diabetes, including foot deformities, infections, ulcers, and amputations.

13. Know Your Neuropathy (Peripheral Neuropathy Symptoms)
Peripheral neuropathy symptoms include:

14. Know Your Neuropathy (Proximal Neuropathy)
Proximal neuropathy can also be called diabetic amyotrophy. That myo in the word means muscle, so this is a form of neuropathy that can cause muscle weakness. It specifically affects the muscles in the upper part of your leg(s), buttocks, and hips.
Proximal neuropathy is the second most common type of diabetic neuropathy (second only to peripheral diabetic neuropathy). It usually affects elderly people with diabetes; as opposed to peripheral neuropathy, it usually resolves with time or treatment.

15. Know Your Neuropathy (Proximal Neuropathy Symptoms)

16. Know Your Neuropathy (Autonomic Neuropathy)
The autonomic nervous system should maintain your body’s homeostasis, which is its normal, balanced state. If the autonomic nerves are damaged by the effects of diabetes— autonomic diabetic neuropathy—then your body may have trouble maintaining homeostasis.
Autonomic neuropathy can seem daunting because it can affect so many of your body’s systems, from your digestive tract to how well you can see. However, remember that your symptoms depend on what specific nerves in the autonomic nervous system are damaged

17. Know Your Neuropathy (Common Autonomic Neuropathy Symptoms)

18. Know Your Neuropathy (Focal Neuropathy)
All of the types of diabetic neuropathy above—peripheral, autonomic, and proximal—are examples of polyneuropathy. Poly means that they affect many nerves. Focal neuropathy, by contrast, affects one specific nerve; it’s focused neuropathy. It can also be called mononeuropathy.
Focal neuropathy, which comes on suddenly, most often affects nerves in the head (especially ones that go to the eyes). It can also affect the torso and legs.
When focal neuropathy affects the legs, it has different symptoms than proximal neuropathy, which can also affect the legs. Proximal neuropathy, as you can read above, causes muscle weakness in the legs, and it may also cause shooting pain down the leg. Focal neuropathy, however, causes pain in very specific locations on the legs, usually go away after a few weeks; these aren’t long-term symptoms.

19. Know Your Neuropathy (Focal Neuropathy Symptoms)

20. Coding Exercise #1
44 y/o patient with type 1 diabetes is recently diagnosed with peripheral neuropathy in both feet.
What is the correct code assignment ??
E11.9 and G62.9
E10.42
E11.40
E10.40

21. Coding Exercise #1 Answer Rationale:
The key words in this scenario hinge on the type of diabetes documented AND the type and location of the neuropathy.

22. Diagnosis Coding for Diabetes Diabetic & Heart Conditions

23. Diagnosis Coding for Diabetes Chronic Kidney Disease

24. Diagnosis Coding for Diabetes: Chronic Kidney Disease and Hypertension
Diabetes Type 2 E11.9
Hypertension I10
CKD (stage 3)
N18.3

26. Diagnosis Coding for Diabetes Chronic Kidney Disease and Hypertension
Diabetes Type 2 E11.9
Hypertension I10
CKD (stage 3)
N18.3
Each diagnosis alone has it’s unique set of codes but when the diagnosis exist together have combination codes
Example:
Type 2 Diabetes with no complications = E Type 2 Diabetes with Stage 3 CKD =E N18.3
Type 2 Diabetes with Stage 3 CKD + hypertension = E11.22
+I12.9
+N18.3
E11.22
+N18.3
No link
E11.22 +
I12.9
N18.3

27. Diagnosis Coding for Diabetes Diabetic Eye Conditions
Diabetic Retinopathy
Diabetic Macular Edema
Diabetic Cataracts
Diabetic Glaucoma

28. Diagnosis Coding for Diabetes Diabetic Eye Conditions--Retinopathy
Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. It is caused by changes in the blood vessels of the retina.
In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision.
If you have diabetic retinopathy, at first you may not notice changes to your vision. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.
Proliferative Retinopathy is a more advanced retinopathy where blood vessels “proliferate” or grow. They can bleed, cloud vision and destroy the retina

29. Diagnosis Coding for Diabetes Diabetic Eye Conditions--Cataract
Cataracts are one of the sight-related complications of diabetes that can cause misting or blurring of vision
Cataracts are cloudy opacifications of the lens of the eye which can lead to cloudy or blurred vision. This interferes with your vision, in some cases considerably

30. Diagnosis Coding for Diabetes Diabetic Eye Conditions--Glaucoma
It’s the result of high fluid pressure inside your eye. This happens when the liquid in the front part of the eye doesn't circulate the way it should.
Normally, the fluid, called aqueous humor, flows out of your eye through a mesh-like channel. If this channel gets blocked, the liquid builds up

31. Diagnosis Coding for Diabetes Diabetic Eye Conditions

32. Coding Exercise #2
44 y/o patient with type 2 diabetes is recently diagnosed proliferative diabetic retinopathy without macular edema or retinal detachment of the left and right eye.
What is the correct code assignment ?? E
E , E E E

33. Coding Exercise #2
Answer

34. Medications for Diabetes
Know your drugs…
There are numerous prescription oral hypoglycemic drugs on the market that are not considered insulin. If you aren’t sure ..research
Z79.84 Long Term (current use) of oral hypoglycemic drugs
Z Long Term (current use) of insulin
Z Presence of insulin pump (external) (internal)

35. Medications for Diabetes Z79.4--Insulin
Some examples of insulin medications on the market (include but not limited to):
Apidra Novolin
Humalog Novolog
Humulin Velosulin
Lantus
Levemir

36. Medications for Diabetes Z79.84—Oral Hypoglycemics
Some examples of oral hypoglycemic medications on the market (include but not limited to):
Actos Invokana
Amaryl Janumet Victoza
Fortamet Jardiance
Forxiga Januvia
Glucovance Prandimet
Glucotrol Metaglip
Glucotrol XL Onglyza
Glucophage Tradjenta
Glynase Tresiba
Glumetza Trulicity

37. Questions???

38. Contact Info
If you think of a question after the presentation or just have general comments you can contact me at
Happy Coding 

39. References
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neuropathy

40. References
neuropathy-symptoms