Posts tagged ‘250’

April 3, 2011

Hyperglycemia does not equal diabetes

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.

November 17, 2010

Gangrene and diabetes are a pair, but not necessarily a commitment

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

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