Medicare Compliance & Reimbursement

"Insulin-dependent" distinctions are no more Providers may find it easier to assign diabetes ICD-9 codes (250-250.9) now that beta cell function drives your determination of both type I and type II diabetes. To take advantage of the new codes, a physician should determine how well a patient's pancreatic beta cells function to distinguish between the diabetes codes' fifth digits, says Beth Fisher, medical systems specialist with the National Center for Health Statistics in Hyattsville, MD.

Physicians now use insulin and non-insulin designations to determine whether patients have type I or type II diabetes -- but the problem with the current system is that physicians often assign a type I diabetes diagnosis to any patient who takes insulin, even though many type II patients use insulin also. That's why the code descrip-tors' deleted insulin designation is a good change that should alleviate a lot of confusion for physicians and coders, Fisher says. Type I diabetes is relatively rare compared to type II. "Statistics demonstrate that only 5 to 10 percent of all diabetics have type I diabetes," which is an autoimmune disorder, says Alison Nicklas, director of education and training for Precyse Solutions, based in King of Prussia, PA. The tendency of coders and physicians to inaccurately over-report type I diabetes diagnoses based on insulin dependence is therefore wrong both for an individual patient and for the overall diabetic population, she adds. Define diabetes based on beta cell function: As of Oct. 1, doctors should separate the two types of diabetes and choose the fifth digits using two methods:

Type I -- The physician should assign 250.x1 or 250.x3 when the patient's pancreatic beta cells no longer produce insulin. Patients with type I diabetes must use insulin.
Type II -- The doctor should use 250.x0 or 250.x2 when the patient's pancreatic beta cells do not function properly and have insulin resistance. Also, type II patients may use insulin, depending on the severity of their condition.

What to expect: Here are the revised fifth-digit descriptors for 250.xx as they should appear in next year's ICD-9 manual:

0 -- Type II or unspecified type, not stated as uncontrolled. In addition to removing "[non-insulin dependent type] [NIDDM type]," CMS also deleted "[adult-onset type]." The "adult" designation led some physicians to inaccurately apply the "0" fifth digit only to adults. Providers can no longer assign diabetes type based on age, because more young people are developing type II diabetes, Fisher says.
1 -- Type I [juvenile type], not stated as uncontrolled. CMS deleted "[insulin dependent type] [IDDM]" from the descriptor. But "juvenile type" remains, because physicians accurately use that designation to assign the "1" fifth digit, Fisher says.
2 -- Type [...]