Primary Care Coding Alert

Choose type I or II dx based on pancreatic beta cell condition Your diabetes coding struggle should come to an end, thanks to ICD-9's simplification of the 250 series. 
 
Starting Oct. 1, you can no longer rely on the patient's insulin use or age when assigning 250's fifth digit. Here's what experts, such as Marie Felger, CPC, a member of the American Academy of Family Physicians (AAFP) FPM Coding & Documentation review panel, say you need to know to accurately report this "biggest ICD-9 2005 change affecting family physician (FP) coders."
 
Don't Use Insulin to Determine Diabetes Type You won't actually need any new digits with ICD-9 2005's diabetic revision. "The 250.xx (Diabetes mellitus) update simplifies diabetes coding," Felger says. The codes' descriptors eliminate any reference to insulin dependence.

What's new: FP coders can no longer determine 250's fifth-digit subclassification based on a patient's insulin use. ICD-9 cleaned up the diabetes language because type II diabetics may also require insulin, Felger says. Therefore, you can't differentiate between type I and II diabetes based on insulin alone. Look to Patient's Beta Cell Condition You instead need to know the condition of the patient's pancreatic beta cells. When the ICD-9 changes take effect at the beginning of October, your physician will need to determine whether the patient's pancreatic beta cells are functioning to distinguish among 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, FPs 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. "These patients need insulin to live," Felger 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, Felger says. "But diet keeps most type II diabetes under control." Ignore Patient's Age ICD-9's diabetic revision also shatters another coding myth: Age doesn't matter when coding 250. "The terms 'juvenile type' and 'adult-onset' confused many coders," Felger says.

Good news: The revised 250.x0 and 250.x2 descriptors eliminates "adult onset." The "adult" definition led some physicians to think that the "0" and "2" fifth digits applied only to adults. But more young people are developing type II diabetes, Fisher says. Prepare for Fall Code Implementation You have no time to waste in getting your office ready for the new diabetes descriptors. In February, CMS scrapped the 90-day grace period [...]