Icd-9 Codes

  1. 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!!!!!
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  2. 16 Comments

  3. by   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
  4. by   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...
  5. by   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.
  6. by   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
  7. by   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))
  8. by   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....
  9. by   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
  10. by   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.
  11. by   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
  12. by   NRSKarenRN
    Kids R Fun has posted great website. I've used it before. If you do not have a coding book in your office you should get one; if you have a book look at the introduction pages---explains how to code to higest degree of specificity.

    This website also has easily understood introduction to coding:
    OFFICIAL ICD-9-CM GUIDELINES FOR CODING AND REPORTING
    http://www.eicd.com/Guidelines/Default.htm


    In addiiton to coding for diabetes as above, when coding leg ulcers along with diabetes---if the leg ulcers are a result of diabetes you should code using 250.8X (plus 5th digit) ---or if due to diabetic neuropathy 250.7X. This will result in higher reimbursement and bring in an additional $2,000 to agency!


    Know that codes are updated each October so need to check for latest codes:
    2002 Updates to the ICD-9-CM Diagnosis Codes
    Effective October 1, 2002
    http://cms.hhs.gov/medlearn/icd9code.asp


    Taking a Closer Look at 2003 ICD-9-CM, DRG Changes
    http://library.ahima.org/xpedio/grou...k1_016283.html

    See if local hospital or community college offers coding course---cost would be ofset by improved reimbursement to your agency.

    E Codes NOT used in homecare---rarely 800-999 codes (Injury and Poisioning).
    Cancer DX are listed under Neoplasms---if unknown if tumor cancerous, use second column code.

    Can also find codes commonly under: Complications, symptoms and deficiency.

    Good luck---let us know if we can help.
    Last edit by NRSKarenRN on Feb 19, '03
  13. by   renerian
    Nice post karen. Very helpful.

    renerian
  14. by   JennyHHRN
    Does anyone have Nancy Mcquire's HH Diagnosis Coding Answer Book? I keep getting e-mails and mailings advertising this book, it sounds like the answer to my prayers but it costs $349! I've been begging my supervisor, but she would like to see it's content before purchasing.
    I have a 2001 ICD book and the front has lots of explanatory direction but none specific to HOME CARE.

    p.s. Nurses in home care are such a rare and special breed. It's so nice to log on to this site and know that others are going through the same things. Even with all of the overwhelming requirements and red tape, I LOVE BEING A HOME CARE NURSE....(yeah, remind me I said this next monday when I want to quit)

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