Pediatric Coding Alert

Look to pancreatic beta cell condition to determine type I, II dx Do you think you score 100 on diabetes claims submissions? You could be in for a big surprise if you don't know ICD-9 2005's 250.xx changes.
 
Starting Oct. 1, you can no longer rely on the patient's insulin use to choose between type I and II diabetes. Here's what experts, such as Jeffrey Linzer Sr., MD, MICP, FAAP, American Academy of Pediatrics representative to the ICD-9-CM editorial advisory board, say you need to know to accurately report this "biggest ICD-9 2005 change." Insulin Alone Doesn't Determine Diabetes Type You won't actually need any new digits with ICD-9 2005's diabetic revision. "The 250.xx (Diabetes mellitus) update is strictly an editorial change," Linzer says. The codes' descriptors eliminate any reference to insulin dependence.
 
The lowdown: Pediatricians can no longer presume that insulin use determines 250's fifth-digit subclassification. ICD-9 updated the diabetes descriptors because type II diabetes patients may also require insulin, Linzer says. Therefore, you can't differentiate between type I and II diabetes based on insulin alone. Beta Cell Function Identifies Diabetes Type You instead need to know the condition of the child's pancreatic beta cells. When the ICD-9 changes take effect this fall, your physician will need to determine whether the patient's pancreatic beta cells are functioning to distinguish between the diabetes codes' fifth digits, says Beth Fisher, medical systems specialist with the National Center for Health Statistics (NCHS) in Hyattsville, Md. The NCHS and CMS oversee all ICD-9 changes.
 
How it works: As of Oct. 1, pediatricians 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 pediatrician should assign this type when the child doesn't have any pancreatic beta cells. "These patients routinely require insulin," Linzer says.

  Type II (fifth digit of 0 or 2) - You should use this designation when a patient's pancreatic beta calls don't function properly, meaning they don't produce enough insulin. Type II diabetics may occasionally need insulin.

Payers May Accept New Codes This Fall You have no time to waste in getting your pediatric practice ready for the new diabetes descriptors. In February, CMS scrapped the 90-day grace period you once had to implement new ICD-9 codes. Medicare based its decision on the HIPAA law that requires you to use the code set that is valid at the time of service. Private payers may follow suit, which means your practice should be ready to use the revised fifth digits on Oct. 1.
 
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, [...]