Otolaryngology Coding Alert

Question: An otolaryngologist diagnoses hearing loss due to neurological deterioration in a patient who has had type I diabetes for 10 years.
 
I noticed that ICD-9 2005 indicates revisions to the diabetes mellitus codes. How will these changes affect my 250.6x coding?

Georgia Subscriber

Answer: The 250.xx (Diabetes mellitus) revisions eliminate any reference to insulin dependence and to adult onset.
 
The revisions mean that you can no longer use a patient's insulin use to determine 250's fifth-digit subclassification. ICD-9 eliminated the terms "non-insulin dependent type" and "insulin dependent type" because type II diabetics may also require insulin. Therefore, you can't differentiate between type I and II diabetes based on insulin alone.
 
You instead need to know the condition of the patient's pancreatic beta cells. Otolaryngologists should separate the two types of diabetes and choose the fifth digits using the following methods:

  Type I (fifth digit of 1 or 3) - The physician should assign this type when the individual doesn't have any pancreatic beta cells. 
  Type II (fifth digit of 0 or 2) - You should use this designation when a patient's pancreatic beta cells don't function properly, meaning they don't produce enough insulin. Type II diabetics may occasionally need insulin, but diet keeps most type II diabetes under control.

The revised 250.x0 and 250.x2 descriptors also eliminate the term "adult onset." The "adult" definition led some physicians to think the "0" and "2" fifth digits applied only to adults. But more young people are developing type II diabetes.
 
Coding example: In your case, you should indicate type I diabetes with 250.61 (Diabetes with neurological manifestations; type I [juvenile type], not stated as uncontrolled) or 250.63 (... type I [juvenile type], uncontrolled). Choose the fifth-digit subclassification based on whether the patient's diabetes is controlled. If the otolaryngologist states that the condition is uncontrolled, report a fifth digit of 3. Otherwise, assign 250.61.