790.21 vs. 790.6 Elevated Fasting Glucose and Medicare

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ICD-9-CM Official Guidelines for Coding and Reporting I would like some feedback from other coders about how they would code a dx of elevated glucose as indicated by a lab value of >90 as part of a CMP. In the past, I have coded these as 790.21 in absence of a dx of DM, however, the following seems to lean towards 790.6. Any thoughts on this?



Medicare National Coverage
Determinations (NCD)
Coding Policy Manual and Change Report
July 2008


190.20 – Blood Glucose Testing
1. A diagnostic statement of impaired glucose tolerance must be evaluated in the context of the documentation in the medical record in order to assign the most accurate ICD-9-CM code. An abnormally elevated fasting blood glucose level in the absence of the diagnosis of diabetes is classified to Code 790.6 - other abnormal blood chemistry. If the provider bases the diagnostic statement of impaired glucose tolerance” on an abnormal glucose tolerance test, the condition is classified to 790.2 -- normal glucose tolerance test. Both conditions are considered indications for ordering glycated hemoglobin or glycated protein testing in the absence of the diagnosis of diabetes mellitus.
 

dmaec

True Blue
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If the dx is for elevated or abnormal glucose - I code 790.29
If it's for impaired fasting glucose I code - 790.21
but, apparently from what you wrote, I shouldn't code the 790.21 for impaired fasting glucose UNLESS they have a dx of DM. I'll have to keep my eye out for that when it comes through!
{that's my opinion on the posted matter}
 
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The way I read it ...

Don't you just love when bureaucrats try to write a definitive statement?

Okay, let's tear this apart and try to figure out what they are saying ...

"An abnormally elevated fasting blood glucose level in the absence of the diagnosis of diabetes is classified to Code 790.6 - other abnormal blood chemistry." Seems clear enough ... if there is no dx of DM, you use 790.6

BUT ..."If the provider bases the diagnostic statement of impaired glucose tolerance on an abnormal glucose tolerance test, the condition is classified to 790.2 -- normal glucose tolerance test." ... so, if there is not dx of DM, BUT the provider does have "a diagnostic statement of impaired glucose tolerance," then you use 790.2x (you need a 5th digit) ... so we're back to 790.21.

Seems to use anything other than 790.6 the MD has to at least state there is impaired glucose tolerance. That's my interpretation ...

F Tessa Bartels, CPC, CPC-E/M
 
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