[JennyHHRN]

Recently our clerical/biller/coding expert took a job elsewhere and in the meantime, myself and a clerical person have been handed the job of assuring the correct codes are on 485's.

HELP!!! WHAT ARE THE CORRECT CODES AND CATEGORIES FOR DIABETES? ARE THE FOLLOWING CORRECT?

*DIAB, TYPE I (juvenile onset)-controlled 250.01
*DIAB, TYPE I (juvenile onset)-uncontrolled 250.03
*DIAB, TYPE II - controlled 250.00
*DIAB, TYPE II - uncontrolled 250.02


-Does it not matter that they are insulin dependent or not???
-If they are insulin dependent do we consider that uncontrolled?
-If they were uncontrolled while inpatient and placed on insulin or an oral antidiabetic and sugars are now within range do we chart controlled or uncontrolled?????
-Can a person be considered Type I diabetic if they had adult onset and are on insulin?

I need a refresher course in endocrinology!!!!!

[sunnygirl272]

from yahoo health...

People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.

There are three major types of diabetes:

Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise. IDDM

Type 2 diabetes is far more common than type 1 and makes up about 90% of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity levels, and widespread failure to exercise. NIDDM


Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes

[sunnygirl272]

NOw...tell us what you think the answers to your questions are, and we will help guide you along....somewhat.....but try doing a search on your own to refresh your diabetic knowledge also...

[kids]

People! She is not just asking for help figuring out DM...she's asking for specific help with coding. I am actually an Certified Medical Claims Ananlyst...which is a fancy way of saying I spent a year in school learning how to do ICD and CPT coding...it is not as simple as it seems, the manual does not always use the same terminology that we are used to and using the wrong code can seriously effect reimbursement.

Jenny:

your codes are missing the 4th digits:

250 Diabetes mellitus

250.0 Diabetes mellitus without mention of complication
250.1 Diabetes with ketoacidosis
250.2 Diabetes with hyperosmolar coma
250.3 Diabetes with other coma
250.4 Diabetes with renal manifestations
250.5 Diabetes with ophthalmic manifestations
250.6 Diabetes with neurological manifestations
250.7 Diabetes with peripheral circulatory disorders
250.8 Diabetes with other specified manifestations
250.9 Diabetes with unspecified complication

source: http://www.cs.umu.se/~medinfo/ICD9/i...roup3.html#250

you still have to have the 5th digit and that is where insulin is factored in...for coding purposes DM is either IDDM or NIDDM regardless of age of onset:
(0) NIDDM not stated as uncontrolled
(1) IDDM not stated as uncontrolled
(2) NIDDM uncontrolled (I believe this is the code used for NIDDM who end up on insulin)
(3) IDDM uncontrolled

I would suggest you register at the link below...for free you can get many common ICD-9 codes (costs money for the ICD-10 codes).
http://www.eicd.com/Default.htm

I would suggest that you READ the section in the ICD-9 manual...pay close attention to words like specified and stated.

Keep in mind that as no one can assign a medical dx except the Doc...however we can read read thru the notes and pick out info that rephrases the dx.

If you need anymore help feel free to PM me.

[renerian]

Yep you need the fifth digit........in your manual it will say use a fifth digit........I have my book right here at home.

I hope you have the 2003 version as there were many changes.

See where you look down the list and it lists the 4 digits with a darkened area for the fifth digit-that list of 0,1,2,3 goes as the 5th digit. Do any of the listed descriptors fit?

renerian

[sunnygirl272]

Originally posted by kids-r-fun
People! She is not just asking for help figuring out DM...she's asking for specific help with coding. I am actually an Certified Medical Claims Ananlyst...which is a fancy way of saying I spent a year in school learning how to do ICD and CPT coding...it is not as simple as it seems, the manual does not always use the same terminology that we are used to and using the wrong code can seriously effect reimbursement.

wtf...Ummm..people....she also asked for help with diabetes....as far as which is which.......sooo...stupid me helped her with part of it,.,,i shoulda left the fargin' thread alone...

((bowing down to the greatness of the Certified Medical Claims Ananlyst))

[JennyHHRN]

WHOA! YOU GALS DON'T NEED TO FIGHT OVER ME!!!
Kids-r-fun: thank you soooo much, you interpreted my message and answered it on the nose!!

Sunnygirl272: thanks for the diabetes factoids, i can use it to educate others around my office who don't realize the intricate differences in the diagnosis of diabetes.

renerian: thanks for the backing up Kids-r-fun, it always helps to have another person in agreement!!!

ps. Renerian and Kids-r-fun: i'm so glad to have found you both!! I have been pulling my hair out trying to explain to the higher ups that we need to rehire a trained coding expert!!! I soo appreciated what you do since they turfed this job to me temporarily. I hope it's okay to consult with you both from time to time.....thanks again....

[renerian]

It is a learned skill that is for sure. I have to code every day and have been doing it for 11 years.

Glad I could help..................sometimes it is hard to get the right response the first time LOL.

renerian

[kids]

You are welcome, I'm glad I could help...coding can be a challenge.

Oh, and excuse me for mis-spelling analyst, I don't think it warrented the reaction it got but I'm not going to play the game even if my feelings are hurt.

Like I said Jenny, feel free to PM me if you need any more help.

[sunnygirl272]

Originally posted by kids-r-fun
...Oh, and excuse me for mis-spelling analyst, I don't think it warrented the reaction it got but I'm not going to play the game even if my feelings are hurt...

thought about making this a pm, but felt the need to defend myself in public...
1) re spelling: honestly did not even notice your misspelling until YOU pointed it out...i had only copy&pasted rather than type your whole title out...

2) normally, you're cool in my book, kids...but you jumped all over my posts and got my dander up....the OP had implied she needed a refresher on DM also...which i attempted to assist with...also wanted to hear her try to figure out her questions herself, also, hence the 2nd post i made...next thing i know you've romped all over me for my post...:

Originally posted by kids-r-fun
People! She is not just asking for help figuring out DM...she's asking for specific help with coding.

that's all i have to say here in public. Jenny...my apologies to you for the catty turn of this thread....
Melinda