Keep diabetes rules in mind during diabetes month

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

1: uncontrolled

7 Comments to “Keep diabetes rules in mind during diabetes month”

  1. There used to be an assumed relationship between DM and gangrene. When did this change?

    • Gangrene is an assumed manifestation of diabetes if the patient has a diagnosis of diabetes and also has gangrene with no other documented cause of the gangrene. A patient can have gangrene but that does not necessarily mean that the patient has a diagnosis of diabetes. A patient can have gangrene either related or unrelated to Diabetes. Hope this helps. Jean

  2. Lisa,
    On slide 40 from the 9-29-10 ICD-9-CM: Coding Essentials for Home Care Professionals Intermediate Level course it says “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.” I took that to mean that, as long as we code DM with circulatory manifestations, the gangrene didn’t need any other codes. Is that correct?

  3. Very clearly written

  4. I had one the other day that the doctor said Diabetes Type I but the patient was not on any insulin, what to do? How would you code it? Let’s have some discussion.

    • I would query the physician. Can a patient have type I DM and then at sometime in life be diagnosed as type II and no longer require insulin? Did this patient have a pancreas transplant and now no longer requires insulin? I would either query the physician or request notes. Is the DM actually type II and was the type I a typo? Anytime in doubt, I believe coders need to get the facts and then code accordingly. I like to treat each scenario that I code as though it is my own personal medical record. Just some food for thought. Thanks. Jean

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