1. Beth Sassano CPC, CCS-P, CPMA, CPC-I Diabetes

2. Diabetes mellitus (DM) is a syndrome characterized by hyperglycemia from impaired insulin production. Associated Risk factors: Diabetic ketoacidosis (DKA) Non-ketotic hyperglycemic-hyperosmolar coma (NKHHC) Late Complications: Retinopathy Nephropathy Atherosclerotic coronary dz Peripheral arterial dz. Neuropathy oect

3. Insulin Normally, insulin made by the pancreas gives the signal to your body’s cells to store glucose from the blood. A person with diabetes body’s cells are unable to store glucose. Without insulin glucose levels in the blood rise and spill over into the urine. Excess amounts of glucose in the blood may affect many organ systems including kidneys, vascular systems, eyes and nerves.

4. Type 1 Diabetes Type 1 Diabetes is AKA insulin – dependent diabetes mellitus (IDDM), juvenile diabetes or childhood onset diabetes. Hereditary accounts for 10%-15% of IDDM patient. Type 1 patients must take insulin from childhood on since the pancreas cannot produce insulin. Treatment is daily insulin injections and diet control. Patients are rarely overweight.

5. Coding type 1 in ICD-9 Use the fifth digit of either “1” or “3” to indicate a person with type 1. Use fifth digit “1” when the providers documentation DOES NOT STATE that the diabetes is uncontrolled Use fifth digit “3” when the documentation states the patient’s condition is uncontrolled. Usually the provider does not document whether the diabetes is uncontrolled. The provider needs to understand the coder cannot choose uncontrolled unless it is clearly stated in the EMR.

6. Type II AKA non-insulin diabetes mellitus (NIDDM) or adult onset diabetes. It makes up approximately 90% of diabetic cases. Onset usually after age 30 and is associated with obesity and/or genetics. Treatment is diet, exercise, and when warranted, oral anti- diabetic or hypoglycemic agents. Type II can be classified as uncontrolled.

7. Common Codes: 250.1x – DM with DKA without coma. 250.2x – DM with hyperosmolarity 250.3x – DM with coma 250.4x – Kidney dz as a complication of DM 250.5x – Indicate DM with ophthalmic complications 250.6x – DM with neurologic complications 250.7x – DM accompanied by PVD or peripheral circulatory disorder 250.8x – Other complications 250.9x – Unspecified complication

8. Secondary Diabetes Secondary Diabetes is classified to category 251.x and is usually the result of therapy or treatment.

9. Code Sequencing Code the diabetic complication first i.e. 250.5x Followed by the code for the complication The diabetes codes and the secondary codes that correspond to them are paired codes that follow the etiology/manifestation convention of the classification. ICD-9 clearly states to list diabetes first when a “code first” note is present.

10. Diabetes outpatient self-management training (DSMT) codes G0108 and G0109 Covered only if the physician or qualified non-physician practitioner who manages the condition certifies that the service as needed and refers the patient to a DSMT program. For Medicare the training must be furnished by a physician, individual or entity that meets the conditions in the 42 CFR 4242.73 or 424.80; 42 CFR 410.142, 42 CFR 410.144; and 42CFR 410.145 and 146.

11. Draft ICD-10 Diabetes will fall under endocrine, nutritional, and metabolic diseases in ICD-10. They are combination codes that include the type of diabetes, the body system affected, and the complication affecting that body system As many codes within a particular category as are necessary to describe all of the complications of the disease may be used Sequencing is based on the reason for a particular visit. Assign as many codes from category E08-E13 as needed to identify all the associated conditions that the patient has.

12. Diabetes in ICD-10 If the type of diabetes is not documented – default to type II diabetes E11- Diabetes and insulin – Type of diabetes not documented but does indicate that the patient uses insulin code E11 for type II AND Z79.4, long term use of insulin (current use) Do not assign Z79.4 if insulin is given temporarily to bring a type II patient’s blood sugar under control/

13. ICD-10 Diabetic complications Underdose of insulin due to pump failure – code T85.6 Mechanical complication of other specified internal and external prosthetic device, implant, and graft that specifies the type of pump malfunction, as the principal dx. is coded to T38.3x6-. Additional codes for the type of diabetes and any associated complications due to underdosing should also be assigned Overdose of insulin due to pump failure – code T85.6- Mechanical complication should be coded to T38.3x1-, poisoning by insulin and oral hypoglycemic drugs accidental.

14. Secondary Diabetes in ICD-10 Sequencing of secondary diabetes due to underlying condition, E09, drug or chemical diabetes, and E113, other specified DM, identify complications/manifestations associated with secondary DM. Secondary DM is always caused by another condition or event (e.g. cystic fibrosis, malignant neoplasm of the pancreas, pancreatectomy, adverse effect of drug, or poisoning). SEE CODING GUIDELINES FOR MORE DETAIL