Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are
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2 Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.
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15 DM w/ketoacidosis DM w/hyperosmolarity DM w/kidney complications RENAL w/o coma with coma w/o nonketotic hyperglycemichyperosmolar coma DM w/diabetic nephropathy DM with CKD with coma DM I (E10) E10.10 E10.11 E10.21 E10.22 an STAGES N18.1 N18.2 N18.3 N18.4 N18.5 N18.6 DM w/ophthalmic complications OPHTHALM IC DM w/unsp Diabetic retinopathy DM I (E10) E10.31 DM II (E11) E11.31 with Macular edema E E without Macular edema E E DM w/mild non proliferative Diabetic retinopathy E10.32 E11.32 with Macular edema E E without Macular edema E E DM w/moderate non proliferative Diabetic retinopathy E10.33 E11.33 with Macular edema E E without Macular edema E E DM w/circulatory complications CIRCULATORY DM w/ other diabetic kidney complication. Ex: Proteinuria (R80.9) DM w/diabetic periph.angiopathy without gangrene DM w/diabetic periph.angiopathy with gangrene DM I (E10) E10.29 NEUROLOGICAL DM I (E10) DM II (E11) DM w/neurological complications DM w/diabetic neuropathy, unsp E10.40 E11.40 DM w/diabetic mononeuropathy E10.41 E11.41 DM w/diabetic polyneuropathy w/diabetic neuralgia E10.42 E11.42 DM w/diabetic autonomic (poly)neuropathy w/diabetic gastroparesis E10.43 E11.43 Diabetes Mellitus due to an underlying condition Drug or chemical induced DM Other specified diabetes mellitus DM w/diabetic amyotrophy E10.44 E11.44 DM w/other diabetic neurological complication E10.49 E11.49 DM II (E11) E10.51 E11.51 E10.52 E11.52 DM w/other circulatory complication E10.59 E11.59 OTHER Code first the underlying condition causing DM Code first poisoning due to drug or toxin, if applicable (T36T65 with 5th or 6th character 14 or 6) Code E08 E09 E13 with Macular edema E E without Macular edema E E DM w/ proliferative Diabetic retinopathy E10.35 DM w/severe non proliferative Diabetic retinopathy E10.34 E11.34 E11.35 with Macular edema E E without Macular edema E E DM w/ Diabetic cataract E10.36 E11.36 DM w/ other diabetic ophthalmic complication DM W ITH OTHER SPECIFIED COM PLICATIONS E10.39 E11.39 And manifestations: H40H42 DM I (E10) DM II (E11) DM with diabetic arthropathy E10.61 E11.61 w/diab. Neuropathic arthropathy E E with other diab. Arthropathy E E DM with skin complications E10.62 E11.62 DM with diabetic Dermatitis E E DM with foot ulcer E E And site L97.4,L97.5 DM with other skin ulcer E E And site L97.1L97.9,L98.41 L98.49 DM with other skin complication E E DM with oral complications E10.63 E11.63 DM with periodontal disease E E DM with other oral complications E E DM with hypoglycemia E10.64 E11.64 with coma E E without coma E E DM with hyperglycemia E10.65 E11.65 DM with other specified complication E10.69 E11.69 And code for complication (Ex: Male erectile dysfunction, unsp.(n52.9) DM with unspecified complications E10.8 E11.8 DM without complications E10.9 E11.9 Insulin Use Z79.4 page 15
16 AHA Coding Clinic, Q2, 2010 confirms that the BMI may be recorded by nonphysician clinicians, but it cannot be reported unless also documented by the physician as associated with a related condition, such as morbid obesity. The BMI, even if it s above 40, cannot be coded alone unless the provider assessed and confirmed the diagnosis. For precise coding of overweight and obesity, the documentation should contain: CONDITION CODE Morbid (severe) obesity due to excess calories E66.01 Morbid (severe) obesity with alveolar hypoventilation E66.2 BMI CODE Body mass index (BMI) , adult Z68.41 Body mass index (BMI) , adult Z68.42 Body mass index (BMI) , adult Z68.43 Body mass index (BMI) , adult Z68.44 Body mass index (BMI) 70 or greater, adult Z68.45 page 16
17 Stage Description GFR (ml/minute) I Kidney damage with normal or raised GFR II Kidney damage with mild reduced GFR 6089 III Moderate reduced GFR 3059 IV Severe reduced GFR 1529 V Kidney failure < 15 or dialysis STAGE CODE DESCRIPTION Stage 1 Slightly diminished function. Kidney damage N18.1 w/normal or relative high GFR. Stage 2 N18.2 Mild reduction in GFR w/kidney damage Stage 3 N18.3 Moderate reduction in GFR. Stage 4 Stage 5 ESRD (End stage renal disease) N18.4 N18.5 N18.6 Severe reduction in GFR. Preparation for renal replacement therapy. Established kidney failure, or permanent renal replacement therapy (RRT). Excludes CKD stage 5 requiring dialysis. Patients with CKD requiring Dialysis. For unspecified N18.9 Severity is not specified CKD and ESRD If Kidney Transplant On Dialysis treatment N18.6 only Z94.0 Z99.2 Code assignment will be based on physician documentation of the specific stage and not the GFR result alone. page 17
18 E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E09.22 Drug or chemic induced diabetes mellitus with diabetic chronic kidney disease E10.22 Type I diabetes mellitus with diabetic chronic kidney disease E11.22 Type II diabetes mellitus with diabetic chronic kidney disease E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease page 18
19 ICD10 Code I12.0 I12.9 I13.0 I13.10 Description Additional codes are needed: Hypertensive chronic kidney disease with CKD stage To identify stage of CKD (N18.5N18.6) 5 or end stage renal disease Hypertensive chronic kidney disease with CKD stage To identify stage of CKD (N18.1N18.4, N18.9) I through 4, or unspecified. Hypertensive heart and CKD with heart failure and To identify heart failure (I50.) and a code to identify stage I through 4 CKD, or unspecified CKD. stage of CKD (N18.1N18.4, N18.9) Hypertensive heart and CKD without heart failure To identify stage of CKD (N18.1N18.4, N18.9) and stage I through 4 CKD, or unspecified. page 19
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40 Reminder: This tool is just an overview about some chronic disorders commonly found in the medical records. Always remember to examine the coding guidelines to determine the final assignment of a code. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.
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