Diabetes ICD-9 guidelines

[atcoleman]

I am auditing a specialty practice and they disagree with me regarding the documentation and coding of ICD-9 pertaining to Diabetes and manifestations.

Does anyone know of any place I can get "black and white" proof of what is required when using a diabetes with manifestation code?

Scenario:

Physician documents type II diabetes, uncontrolled. No where in that visit's documentation does it mention any manifestations. But the coding they provide is diabetes type II uncontrolled with renal manifestation. Nor do they provide information on what the actual manifestation is.

Their argument is that in the patient's chart, it has previously been noted that they have diabetes with chronic kidney failure.

My statement is that if they are going to bill for diabetes with manifestations, this has to be clearly noted as such...ie. diabetes type II, uncontrolled with associated chronic kidney failure, stage 3.

Can any give me some direction here?
Thanks,
Tina Coleman CPC, CPMA

[btadlock1]

Originally Posted by atcoleman

I am auditing a specialty practice and they disagree with me regarding the documentation and coding of ICD-9 pertaining to Diabetes and manifestations.

Does anyone know of any place I can get "black and white" proof of what is required when using a diabetes with manifestation code?

Scenario:

Physician documents type II diabetes, uncontrolled. No where in that visit's documentation does it mention any manifestations. But the coding they provide is diabetes type II uncontrolled with renal manifestation. Nor do they provide information on what the actual manifestation is.

Their argument is that in the patient's chart, it has previously been noted that they have diabetes with chronic kidney failure.

My statement is that if they are going to bill for diabetes with manifestations, this has to be clearly noted as such...ie. diabetes type II, uncontrolled with associated chronic kidney failure, stage 3.

Can any give me some direction here?
Thanks,
Tina Coleman CPC, CPMA

Section IV, C & H of the ICD-9 Conventions states to list conditions that are supported by documentation in the medical records. Check with your MAC for guidance regarding listing of diagnoses for each encounter - you should be able to find a publication that will instruct ptoviders that each encounter note should be able to stand alone. If they wish to refer to information from a previous encounter to support billing a particular diagnosis, that information should be referenced specifically in the current encounter note. The important thing for them to remember is, they don't want it to appear that they're just making stuff up. They should be able to rationalize any code selected through information documented in the chart. Hope that helps!