ED Coding and Reimbursement Alert

Question: A patient with type II uncontrolled diabetes reports to the ED. During the course of a level-three E/M, the physician notes ophthalmic and circulatory diabetic manifestations, in the form of a cataract and angiopathy. What is the appropriate diagnosis coding for this visit? Montana Subscriber Answer: You don't have to choose which manifestation to report. Coders are free to report multiple manifestations for diabetic patients, and doing this will paint a more complete picture of the individual patient for the insurance company. However, make sure that for every ICD-9 code for diabetes with manifestation, you include a secondary diagnosis to identify the manifestation. Remember to report the specific diabetes code first, and then the corresponding chronic manifestation code as the secondary diagnosis. On the claim, report the following: - 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M - 250.52 (Diabetes with ophthalmic manifestations; type II or unspecified type, uncontrolled) linked to 99283 to represent the ophthalmic manifestation - 366.41 (Diabetic cataract) linked to 99283 to show the type of ophthalmic manifestation - 250.72 (Diabetes with peripheral circulatory disorders; type II or unspecified type, uncontrolled) linked to 99283 to represent the circulatory manifestation - 443.81 (Peripheral angiopathy in diseases classified elsewhere) linked to 99283 to represent the type of circulatory manifestation. -- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.