Diabetes Mellitus. and coding the complications that can occur

Transcription

1 Diabetes Mellitus and coding the complications that can occur

2 As a coder.don t get stuck in neutral You have to keep moving forward with the new compliances and codes

3 Diabetes Mellitus with. let s take a look at: Section 1.15 With (in the General Guidelines) The word with or in should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. (At this point we aren t even talking about the documentation or note yet.) The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between the two conditions (e.g., sepsis guideline for acute organ dysfunction that is not clearly associated with the sepsis ).

4 Section 1.15 (continued) For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related. The word with in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. For example: Diabetes, diabetic (mellitus)(sugar) E11.9 with amyotrophy E11.44 arthropathy NEC E11.618

5 Section B. 9 Combination Code (General Coding Guidelines) A combination code is a single code used to classify: Two diagnoses, or A diagnosis with an associated secondary process (manifestation) A diagnosis with an associated complication Combination codes are identified by referring to sub-term entries in the Alphabetic Index and by reading the inclusion and exclusion notes in the Tabular List Assign only the combination code when that code fully identifies the diagnostic conditions involved or when the Alphabetic Index so directs. Multiple coding should not be used when the classification provides a diagnosis. When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code.

6 Going back to the General Guidelines for a moment: Section 1.A.9 a. Other codes Codes titled other or other specified are for use when the information in the medical record provides detail for which a specific code does not exist. Alphabetic Index entries with NEC in the line designate other codes in the Tabular List. These Alphabetic Index entries represent specific disease entities for which no specific code exists so the term is included within an other code. In other words, the provider documented information to support a code not currently available in the ICD 10. I believe other codes and unspecified codes are misused frequently because providers and coders are not thinking about the true way in which these codes should be chosen and applied to the documentation.

7 What would be a DM example of a combination code that meets the other code criteria? When a provider documents DM with a circulatory complication and wants to use the code E11.59 Type 2 DM with other circulatory complications. The DM and the complication must be linked in the documentation. Why? Because the complication is not listed in the with column as being presumed to be with the DM.

8 Taking a look at the example of E11.59 The provider documents that a patient has a systemic circulatory problem of erectile dysfunction and it is connected, caused, due to, or linked to the DM as a complication. When looking up the DM in the ICD 10, we default to Type 2 because there is no documented support for Type1 in the note. Looking in the ICD 10 Alpha Listing, there is no complication of ED listed in the with subcategory, but the provider has noted it is a circulatory issue for the patient in the note. So, we need to code it. E11.59 is the combination code for DM with an other circulatory complication. Since we have documented support of what the other code is, we would sequence the ED (impotence) of N52.9 directly following the E11.59 to tell the complete picture the provider is conveying in the note of the combined dx of DM and ED.

9 DM, comorbidities and complications Oh my!! HTN Nephropathy CKD CVD Retinopathy Neuropathy If one chronic condition hangs out too long in the body - a bunch more will gather!!! CKD affects 13% of Americans. Diabetic nephropathy is the most common cause of ESRD in the US. Over 70% of Stage 5 and ESRD in the US are due to DM, HTN or CVD. Diabetic Retinopathy is present in about 35% of all diagnosed diabetic patients. Diabetic neuropathies are the most common complication of DM affecting up to 50% of older patients with type 2 diabetes.

10 Remember to Code - Long term (current) use of insulin There is no timeline indicated to use these long-term insulin codes of Z79.4 and Z79.84 Long term (current) use of oral medication for DM Dialysis Hyperglycemia is coded to E11.65 Hypoglycemia is coded to E or E11.649

11 Neuropathies Polyneuropathy - This is the most common form of diabetic peripheral neuropathy Longer nerves are especially vulnerable, hence the impact on the foot. Poly - many Neuro - Nerve pathy - disease Diabetic Autonomic (poly) Neuropathy DAN - This can be an isolated neuropathy condition or it can coexist with other neuropathies. Clinical manifestations (signs or symptoms of the disease) include, resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, and more. Isolated peripheral neuropathy Mononeuropathy is involvement of just one nerve. This neuropathology has been attributed to vascular ischemia or trauma damage. Cranial and femoral nerves can be involved.

12 Lets code something!!!!