Medicare Compliance & Reimbursement

Insulin urban legend can make your life difficult. Myth: You should list your patient as having Type I diabetes if the patient needs insulin.

Fact: You can use 0 or 2 as the fifth digit even if the patient needs insulin. Some Type II diabetics require insulin. In these cases, you should add V58.67 (Long-term [current] use of insulin) in those cases.

Warning: If you're using an outdated ICD-9 book or "cheat sheet," you may not realize the rules for 250.xx changed on Oct. 1, 2004, says coding expert Marie West. Since then, the fifth digit depends on pancreatic functioning, not insulin use.

Many physicians continue to base their diagnosis of Type I or Type II on insulin dependency, because it's "too much of a hassle" to test the patient's pancreas, says George Ward, billing supervisor with South of Market Health Care in San Francisco.

But it's an important distinction, says diabetes educator Beverly Dyck Thomassian. The difference between the two types doesn't depend on the treatment, but on the patient's pathology and what caused the problem, she adds.