Primary Care Coding Alert

Reader questions:

Remember Primary Dx Code for These Diabetics

Published on Thu Feb 25, 2010

Question: I have a puzzling claim in front of me. The notes indicate that the nonphysician practitioner (NPP) provided an E/M service for an established patient with "2ndary diabetes w/renal manifest." Do I have enough information to choose a diagnosis code with these notes? Michigan Subscriber

Answer: You have enough there to choose 249.40 (Secondary diabetes mellitus with renal manifestations; not stated as uncontrolled or unspecified) for the patient's secondary diabetes.

To paint a complete diagnosis picture for these patients, however, you also need to code the associate condition. So let's say that the patient's diabetes was caused by Kimmelstiel-Wilson syndrome. On the claim, you'd report the following:

• 249.40 to represent the patient's secondary diabetes;

• 581.81 (Nephrotic syndrome; with other specified pathological lesion in kidney; nephrotic syndrome in diseases classified elsewhere) to represent the Kimmelstiel-Wilson syndrome.

Also: Include V58.67, (Long-term [current] drug use; Long-term [current] use of insulin) if the notes indicate associated insulin use.

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