Coding Diabetes

tfischer

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I am trying to get the Doctors in our group to be more specific on their diagnosis coding, especially on Diabetes because there are so many of them in the ICD-9 book, along with Hypertension.

I am having trouble distinguishing between Type I and Type II. Type I is Juvenile Type, but I have heard two different things on it. I was told Type I is usually diagnosed before the age of 30. Then, someone told me that Type I was the insulin dependent Diabetes. I have only been coding what the Doctor is specifying it as, but I guess I need to know if the insulin Dependent is the Type I. Can anyone help me?

Thanks! :)
 

Lashel

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Type 1 aka Juvenile diabetes is insulin dependent. Type 1 diabetes is when the patient's body does not produce insulin, therefore making them insulin dependent.

Type 2 aka adult onset is usually controlled by diet and medications, although these patients may sometimes require insulin injections, they are not dependent on them.

Hope that helps.
 

mitchellde

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However in a transmission released by the CDC they expressed that with so many obese children we now have more type II children than ever before. The key to type I and type II has to do pancreatic beta cell function. A patient with no pancreatic beta cells (or non-functioning) has no capability to produce insulin and are therefore type I. Type II patients do have pancreatic beta cells but either they are not producing enough insulin or their body is insulin resisitant therefore a type II patient may require insulin. It is important to recognise that Diabetes type is not dependent on age or insulin use. Then there is Secondary diabetes which must be documented as being causal to something else, such as pancreatic cancer or adverse reaction to drugs or something else along those lines. I believe it was 2005 that coding clinics had an excellent section on diabetes.
Debra Mitchell, MSPH, CPC-H
 
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Diabetes Coding

I have a doctor who goes back and forth between type 1 and type 2 for the same patient. When I get into a discussion with him about this, he gets into the physiology of diabetes. In the coding world, shouldn't they be one or the other? I can see where a type two could become a type one, but how can they go back to a type to again?

Thanks

Heather
 

mitchellde

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Unless you have a pancreatic transplant there is no way to convert from a type I to a type II. I am not sure how he is explaining the physiology of diabetes without getting into pancreatic beta cell function, the islets of langerhans are the part of the pancreas that house the pancreatic beta cells. These are the key to diabetes type. Now you might question your physician as to whehter he is referring to primary diabetes(category 250) or secondary diabetes (category 249) primary diabetes is due to either genetics or environmental causes and is classified as either type I or type II. Secondary diabetes is due to other things like pancreatic cancer, adverse reaction to steriods, infections.
Let me know if this helps at all.
 
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