ED Coding and Reimbursement Alert

Question: I have a puzzling claim in front of me. The notes indicate that the nonphysician practitioner (NPP) provided an E/M service for a patient with "2ndary diabetes w/renal manifest." Do I have enough information to choose a diagnosis code with these notes?

South Dakota Subscriber

Answer: You have enough there to choose 249.40 (Secondary diabetes mellitus with renal manifestations; not stated as uncontrolled or unspecified) for the patient's secondary diabetes. To paint a complete diagnosis picture for these patients, however, you also need to code the associated condition. So let's say that the patient's diabetes was caused by Kimmelstiel- Wilson syndrome. On the claim, you'd report the following:

• 249.40 to represent the patient's secondary diabetes
• 581.81 (Nephrotic syndrome; with other specified pathological lesion in kidney; nephrotic syndrome in diseases classified elsewhere) to represent the Kimmelstiel-Wilson syndrome.