Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
CIRCULATORY DM w/circulatory DM w/diabetic periph.angiopathy without complications gangrene DM w/diabetic periph.angiopathy with gangrene DM w/other circulatory complication DM I (E10) DM II (E11) E10.51 E11.51 E10.52 E11.52 E10.59 E11.59 DM I (E10) DM II (E11) NEUROLOGICAL DM w/neurological DM w/diabetic complications neuropathy, unsp E10.40 E11.40 E10.41 E11.41 E10.42 E11.42 DM w/diabetic autonomic (poly)neuropathy w/diabetic gastroparesis E10.43 E11.43 DM w/diabetic amyotrophy E10.44 E11.44 DM w/other diabetic neurological complication E10.49 E11.49 DM w/diabetic mononeuropathy DM w/diabetic polyneuropathy w/diabetic neuralgia DM w/OTHER SPECIFIED COMPLICATIONS DM I (E10) DM II (E11) DM with diabetic arthropathy w/diab. Neuropathic arthropathy with other diab. Arthropathy E10.61- E11.61- E10.610 E10.618 E11.610 E11.618 E10.62E11.62DM with skin complications DM with diabetic Dermatitis E10.620 E11.620 DM with foot ulcer E10.621 E11.621 And site L97.4-,L97.5DM with other skin ulcer E10.622 E11.622 And site L97.1L97.9,L98.41-L98.49 E10.628 E11.628 DM with other skin complication DM with oral complications DM with periodontal disease DM with other oral complications DM with hypoglycemia with coma without coma DM with hyperglycemia DM with other specified complication DM with unspecified complications DM without complications Insulin Use E10.63E10.630 E10.638 E11.63E11.630 E11.638 E10.64E10.641 E10.649 E11.64E11.641 E11.649 E10.65 E11.65 E10.69 E11.69 And code for complication (Ex: Male erectile dysfunction, unsp.(N52.9) E10.8 E11.8 E10.9 E11.9 Z79.4 OTHER Code Diabetes Mellitus due to an underlying condition Code first the underlying condition E08 Drug or chemical induced DM Code first poisoning due to drug or toxin, if applicable (T36-T65 with 5th or 6th character 1-4 or 6) E09 Other specified diabetes mellitus E13 ICD-10-CM Coding Examples for DM 1 - Patient with severe non-proliferative diabetic retinopathy with macular edema due to insulin-dependent DM II - DMII with severe non-proliferative diabetic retinopathy with macular edema (E11.341) and Long-term use of insulin (Z79.4). Rationale: Combination code. No other code is necessary. 2 - Type 1 diabetes mellitus with moderate non-proliferative diabetic retinopathy with macular edema - Code E10.331 that includes: Type of diabetes, Body system involved and complications of the body system. No additional codes are necessary. 3 - DM II with complications with moderate diabetes-related CKD. - Type 2 diabetes mellitus with diabetic CKD (E11.22) and CKD, stage 3 (moderate) (N18.3). Rationale: A note under the code for DM II with diabetic CKD instructs to use an additional code to identify the stage of CKD (N18.1–N18.6). 4 - A type 2 diabetic patient is evaluated for a chronic diabetic left foot ulcer with necrosis of muscle. The patient takes insulin on a daily basis. - Type 2 DM with foot ulcer (E11.621), Non-pressure ulcer of other part of left foot w/necrosis of muscle (L97.523) and long-term (current) use of insulin (Z79.4). Rationale: Note under code E11.621 states to use additional code to identify site of ulcer (L97.4-L97.5-) 5 - Secondary diabetes due to pancreatitis; diabetic hyperglycemia on insulin - Idiopathic acute pancreatitis (K85.0). Code first underlying condition - DM due to underlying condition with hyperglycemia (E08.65). Secondary DM code - Long-term (current) use of insulin (Z79.4) 6 - Patient with Type 2 diabetes is diagnosed with bilateral macular edema and bilateral microaneurysms of the retina. The patient’s diabetes is out of control. - DM2, macular edema (E11.311) - Bilateral Microaneurysm (H35.043) - Hyperglycemia (E11.65) Diabetes Mellitus E08-E13 ICD-10-CM References library.ahima.org/xpedio/groups/public/documents/ahima/ bok1_049595.hcsp?dDocName=bok1_049595 www.codeitrightonline.com/ciri/coding-diabetes-mellitus-in-icd-10cm.html www.hcpro.com/HIM-282660-8160/ICD9CM-vs-ICD10CM-Examine -the-differences-in-diabetes-coding.html static.aapc.com/a3c7c3fe-6fa1-4d67-8534-a3c9c8315fa0/db0bf111b6ae-4902-9b35-4b9da2a0a480/7530ff45-c4c8-4bdd-9caa21084c3855da.pdf www.justcoding.com/icd-10 www.hipaaspace.com/Medical_Billing/Coding/ International_Classification_Of_Diseases/ICD10_Codes_Lookup.aspx Centers for Medicare and Medicaid Services. "2012 ICD-10-CM and GEMs." www.cms.gov July 2016 Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Diabetes Mellitus and ICD-10-CMS One of the major changes in the guidelines from ICD-9-CM to ICD-10-CM is coding for Diabetes mellitus. This is due to the creation of combination codes that are greatly used in coding for diabetes conditions. In ICD-10-CM, those codes include the type of diabetes, body system affected and the specified complications involving the body system. The creation of these expanded combination codes permit for multiple conditions to be reported with fewer codes. The type of DM is mentioned first in order to assign the most appropriate codes. The digits will represent the status of the condition as: 3rd- Type of Diabetes 4th- Underlying conditions with specified complications 5th-Specific manifestation, such as neuropathy, angiopathy. The terms controlled and uncontrolled are no longer used for diabetes in ICD-10. Instead, DM that is uncontrolled will be coded as DM with hyperglycemia There are 5 categories for Diabetes broken down according to the type. Codes from categories E08-E09 have a “code first” note indicating that diabetes is to be sequenced after the underlying condition, drug or chemical that is responsible for the diabetes, if applicable. Codes begin with an E (for Endocrine). Alpha characters are not E08 – Diabetes mellitus due to underlying condition (Code first the underlying condition such as Cushing’s syndrome (E24.-). Example: DM due to underlying condition with diabetic nephropathy. Code: E08.21. E09 – Drug or chemical induced diabetes mellitus. Code first (T36-T65 from the table of drugs and chemicals) to identify drug or chemical, if applicable. Use additional code to identify any insulin use (Z79.4). Ex: A physician documents an initial encounter with a patient who has corticosteroid-induced diabetes mellitus without complications. Codes: T38.0X5A, adverse effect of glucocorticoids and synthetic analogues, initial encounter and E09.9, drug or chemical induced diabetes mellitus without complications Codes from categories E10-E13 DM are sequenced first, followed by codes for any additional complications outside of these categories, if applicable. E10 – Type I diabetes mellitus (DM is sequenced first) Example: A patient with type 1 diabetes has developed moderate nonproliferative diabetic retinopathy. Code: E10.339 (type 1 DM with moderate nonproliferative diabetic retinopathy without macular edema) E11 – Type 2 diabetes mellitus (DM is sequenced first) Example: Patient with Diabetes and ESRD on dialysis. Codes: E11.22, (DMII with CKD) N18.6 (stage) Z99.2 (dialysis) E13– Other specified diabetes mellitus (Includes DM due to genetic defects, postpancreatectomy, postprocedural and secondary diabetes mellitus NEC. Coding References by System Some Characteristics case-sensitive. If the type is unclear or not documented, Diabetes mellitus, type II (E11.-) would be used as default. ICD-10-CM provides coders with a much greater range of codes to choose from in the E08–E13 (Diabetes mellitus) series. As a result, providers must document additional information to describe complications of Diabetes. Diabetes codes in ICD-10-CM can have up to 6 characters. The first 3 characters represent the category. The 4th character identifies the presence of manifestations or complications. The 5th and 6th characters identify specific types of manifestation. Categories E08-E09 and E11-E13 related to DM, include a note regarding the usage of an additional code to identify any insulin use. Code Z79.4 Long-term current use of insulin will identify the use of insulin for diabetic management, routinely used. It is not correct to assign Z79.4 in the category E10 codes. On patients with type 1 diabetes, the use of insulin is required therefore Z79.4 is redundant. New Diabetic complications include: Diabetes with skin complications; with oral complications and with arthropathy. Ophthalmic conditions are expanded as well. As with all complications, the documentation must link the condition to the diabetes. Example: CKD, stage IV due to diabetic nephropathy (E11.21/N18.4). Documenting diabetic with complications entails connecting the Diabetes to the specific complaint by noting the complication is diabetic or stating that it is secondary to diabetes. Documenting the associated signs, symptoms and any results of studies is important to support the diagnosis. ICD-10-CM does not presume a connection between osteomyelitis and Diabetes. The relationship between both conditions needs to be documented by the Physician in order to be coded as such. The default for DKA (Diabetic Ketoacidosis) is Diabetes type 1. There is no Index entry to report this diagnosis in patients with type 2 diabetes. There is no current mechanism in ICD-10-CM to report hyperosmolarity in a patient with DM I. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 diabetic patient’s blood sugar under control during an encounter. Comparison A 50 years old female with DM I and HTN was recently diagnosed with diabetic nephropathy. Patient comes to the office for insulin adjustment. ICD –9-CM 250.41: DM I with renal manifestations, not stated as uncontrolled 583.81: Nephritis & nephropathy, not specified as acute or chronic, in diseases classified elsewhere 401.9 : HTN, unspecified ICD-10-CM E10.21: DMI with diabetic nephropathy I10 : Essential (primary) HTN DM I (E10) RENAL DM w/ketoacidosis DM w / hyperosmolarity DM w/kidney complications w/o coma E10.10 with coma E10.11 DM II (E11) w/o nonketotic hyperglycemichyperosmolar coma E11.00 with coma E11.01 DM w/ diabetic nephropathy E10.21 DM w/CKD E11.21 E10.22 and E11.22 STAGES DM w/ other diabetic kidney complication. Ex: Proteinuria (R80.9) N18.1 N18.2 N18.3 N18.4 N18.5 CKDI CKDII CKDIII CKDIV CKDV END+ N18.6 Dialysis(Z99.2) CKD, unsp. N18.9 E10.29 E11.29 OPHTHALMIC DM I (E10) DM with DM w/unsp. Diabetic ophthalmic retinopathy E10.31complications with Macular edema E10.311 DM II (E11) without Macular edema DM w/mild non proliferative Diabetic retinopathy E10.319 E11.319 E10.32- E11.32- with Macular edema E10.321 E11.321 without Macular edema DM w/moderate non proliferative Diabetic retinopathy E10.329 E11.329 E10.33- E11.33- with Macular edema E10.331 E11.331 without Macular edema E10.339 E11.339 DM w/severe non proliferative Diabetic retinopathy E11.31E11.311 E10.34- E11.34- with Macular edema E10.341 E11.341 without Macular edema E10.349 E11.349 DM w/ proliferative Diabetic retinopathy E10.35- E11.35- with Macular edema E10.351 E11.351 without Macular edema E10.359 E11.359 E10.36 E11.36 E10.39 E11.39 DM w/ Diabetic cataract DM w/ other diabetic ophthalmic complication And manifestations: H40-H42