November 28, 2012
There’s a lot of hype about the world ending in 2012. I don’t believe that, but it reminds me of an REM song & M1024—“It’s The End of the World as We Know It.”
Why? M1024 and its predecessors, M0245 and M0246 have been a part of our home health coding world since 2003 when we started using V codes in our coding. Medicare’s final rule for PPS 2013 limits the use of M1024 to only one particular instance for payment diagnoses beginning Jan. 1, and the plan is to decimate it all together once ICD-10-CM is ushered in Oct. 1, 2014. I applaud deleting M1024 from the OASIS, but I desire a different outcome with the remnants of M1024.
M1024 will be used for fractures only beginning in January. Medicare, in a surprise move, stated that resolved conditions do not belong in M1024 and we shouldn’t have been earning points there. CMS reports that the change will be minimal to our case mix scoring, however other sources report that as many as 60% of our assessments include resolved case mix diagnoses in M1024—that will mean a drop in our payment.
We can still get primary points for diabetes, Neuro 1 and Skin 1 case mix diagnoses if we sequence correctly without using M1024 according to Medicare’s grouper change. But, there is one frequently used method for coding that can mean the end of those points if coders are not careful (less points = less money for those who need it spelled out).
I have a short recording on the change to M1024 that will be posted on my website soon and do not miss the opportunity for more in-depth instruction on the change and its impact in upcoming classes in Dallas and Corpus Christi in December. Check my website for details.
So, it’s the end of the world as we know it. It remains to be seen if we’ll “feel fine.”
June 13, 2012
Between 1997 and 2006 heart disease and stroke deaths in diabetic patients fell because of better disease management, but the average life expectancy of diabetics is still shorter than Americans without diabetes.
A study, conducted by the Centers for Disease Control and Prevention, and in conjunction with the National Institutes of Health, found, among other improvements, that deaths related to heart disease and stroke dropped by 40%. Adult diabetics are still likely to die at a younger age than one who does not have diabetes.
On average, people with diabetes were less likely to smoke and more likely to be physically active than in the past. However, obesity levels among people with diabetes continued to increase.
To learn more, go to CDC’s diabetes home page. The study appears in the journal Diabetes Care.
March 14, 2012
From the Centers for Disease Control and Prevention …
The rate of leg and foot amputations among U.S. adults aged 40 years and older with diagnosed diabetes declined by 65% between 1996 and 2008, according to a new study by the Centers for Disease Control and Prevention (CDC).
The CDC attributes better blood glucose control, foot care, and diabetes management, along with a drop in heart disease, as likely reasons that the number of amputations has fallen.
Diabetes is the leading cause of nontraumatic amputations of feet and legs among U.S. adults.
The age-adjusted rate of nontraumatic lower-limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996.
To learn more, go to the CDC site on diabetes.
January 23, 2012
Some recent studies show that web-based tools are not effective in diabetes management. The good news, however, is that CMS still has brochures and other information to help patients, whether they have diabetes or not, learn about services.
August 16, 2011
Intermediate coders, get all the latest information on changes and the best coding education around. I’m
- Explain CMS guidance on sequencing.
- Explain the relevance of OASIS C data items for diagnoses to payment.
- Explain coding of diagnoses of infections, neoplasms, endocrine disorders such as diabetes, anemias, mental disorders, and the nervous system & sense organs.
- Identify the differences between different kinds of ulcers.
- Describe the purpose and appropriate use of V and E codes.
- And tons more … including identifying new codes that will take effect October 1, 2011.
I will be in Dallas Aug. 24-25; McAllen Aug. 31-Sept. 1; Houston, Sept. 7-8
IntermediateTourAugSep2011-1: Register and learn more!
June 13, 2011
Question: We have a doozie of a patient.
He was discharged from an inpatient stay at the hospital for abscess under the right axilla for which he had an I&D. We are seeing him for wound care following this procedure. The wound is clean now without any infection presently. He also had a pulmonary embolism that was treated in the hospital with lovenox and Coumadin. He is still on Coumadin, of course, and this affects his dressing changes as he bleeds quite a bit during the dressing changes. Plus we will be monitoring his PT/INRs of course. He also has LE DVT.
The primary reason that we are seeing him is the wound care.
He is a type 2 diabetic (fairly recently diagnosed) and just started on Levamir while in the hospital. This may delay wound healing, so I know that it needs to be pretty up in the diagnosis chain.
Past history includes CA of the appendix (which has been removed surgically), but this metastasized to the abdomen (does not give specific organ, but I am assuming colon because he has a colostomy) and the lung. He is independent with his colostomy, so I know not to code “ATTN TO” on this one. He also has hx of prostate CA as well.
His cancer is still active as he is on chemotherapy. It is just on hold related to the fact that he had the abscess.
He is morbidly obese, has HTN (with several meds) and GERD.
I am in desperate need of assistance on this one.
Lisa says: He’s a doozie all right!! I think I would still code the wound as an abscess. Follow with the PE, DVT, diabetes, HTN, secondary site(s) of Ca. Follow with V58.83, V58,61, V44.3 and the rest of the codes. Once you’ve coded the primary, you just have to consider the seriousness of the other conditions and importance to the POC. Push your V codes to the bottom.
April 3, 2011
Symptom coding can trip up many coders. These codes should be used in lieu of an official diagnosis, but sometimes we do the reverse: we could a specific diagnosis based on symptoms.
Don’t do that. You need an official diagnosis in order to code.
Consider your patient with hyperglycemia (790.2x) … that’s a symptom of diabetes. Perhaps the patient also has circulatory issues? All of the signs (or symptoms, more accurately!) indicate diabetes (Category 249 or Category 250) … except for the fact that nowhere in the patient records does it say that the patient is diabetic.
Query the doctor. Do not code the diabetes, or any other disease, based on symptoms.
January 26, 2011
The CDC just came out with new figures on diabetes in the United States:
More than 26 million Americans now have the disease, and about one-third of adults have prediabetes.
Check out the CDC page.
November 17, 2010
My recent diabetes posting has generated a few questions:
Question: Even though diabetes may be the number one cause of a problem or is a major cause of a problem, the only manifestations that can be assumed are gangrene and osteomyelitis. Does that mean that as long as we code DM with circulatory manifestations, the gangrene doesn’t need any other codes?
Question: There used to be an assumed relationship between DM and gangrene. Has that changed?
Lisa says: Gangrene and diabetes are always a fun pair to code! In answer to these questions:
You still need to code the osteomyelitis or the gangrene with your diabetes code. So diabetic gangrene is 250.7x, 785.4. The medical assumption does not mean you skip the manifestation code.
What I meant by “number one cause of a problem or is a major cause of a problem” is that a lot of coders will assume relationships between diabetes and other potential manifestations such as CKD. Just because the patient has diabetes and it is a major cause of CKD does NOT mean that the CKD can be assumed to be diabetic. Besides gangrene and osteomyelitis, other potential manifestations need physician confirmation.
There is an assumed relationship of gangrene and diabetes, that has not changed. What I was trying to explain, and I hope I do a better job of it here, is that while gangrene is an assumed manifestation of diabetes, it does NOT follow that having gangrene means that you have diabetes. Gangrene can be a stand-alone problem, so make sure the patient has diabetic gangrene.
November 16, 2010
November is American Diabetes Month, so I wanted to highlight some information and resources about this too-common (and often miscoded) disease.
See the American Diabetes Association’s web page with updated information related to the disease
The CDC recently updated its diabetes website with information on end-stage renal disease and diabetes.
As for coding, remember these points to ensure more accurate coding:
- Insulin use does not indicate a diabetes type. While Type I diabetics are dependent on insulin, many Type II diabetics also use insulin. Query the doctor.
- For Type II diabetes, use of insulin requires a V58.67 code. It is not needed for Type I diabetes because all Type I diabetics use insulin.
- While gangrene is an assumed manifestation of diabetes, it does NOT follow that having gangrene means that you have diabetes. It can be a stand-alone problem, so make sure the patient has diabetic gangrene.
- The diabetes code (249.xx or 250.xx) must always precede the manifestation, even if the manifestation is the focus of care.
- A 4th digit of 1, 2, or 3 would rarely be used in home health settings.
- 5th digit indicates type and control with Category 250. Again … 5th digit indicates type and control. Watch the wording and the documentation because the key is whether “uncontrolled” is mentioned in documentation.
0: Type II or unspecified type, not stated as uncontrolled
1: Type I, not stated as uncontrolled
2: Type II or unspecified type, uncontrolled
3: Type I, uncontrolled
- For Secondary Diabetes, 249.xx, the 5th digit indicates control. There is no type.
0: Not stated as uncontrolled, or unspecified