Wiki Diabetes coding question

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Hello! My question is in regard to diabetes coding and the guidelines. As you know, "with" is immediately listed under the main term "Diabetes, diabetic". If the patient has hypertension, CKD and diabetes, I understand the guidelines tell us we are to presume a causal relationship between diabetes and CKD and use code E11.22; however, if the documentation clearly indicates the diabetes is without complications, what code do we use for the diabetes? E11.9? Thank you in advance for your assistance.
 
As read your question, it seems to me to boil down to whether or not 'without complications' should be interpreted to mean the CKD is unrelated to the diabetes. I've not seen guidance that addresses this specifically. The safest bet would be to query your provider for clarification. Without additional information, I would probably stick with E11.22 since the guidelines do say to presume the causal relationship when it's not clearly stated that the conditions are unrelated.
 
Hi Everyone!
I'm so confused about E11.9 because I had a training with Premera coding team a few weeks back.
They had told me that E11.9 can mean neither hypo or hyperglycemia. I always thought it meant no complications (no manifestation).
What are your thoughts?
Thanks for your help!
-Elaine
 
Hi Everyone!
I'm so confused about E11.9 because I had a training with Premera coding team a few weeks back.
They had told me that E11.9 can mean neither hypo or hyperglycemia. I always thought it meant no complications (no manifestation).
What are your thoughts?
Thanks for your help!
-Elaine

I am not sure what your question is, but,
DM with hypo or hyperglycemia has it's own codes:
E11.64x and E11.65, so they would not be coded as E11.9
 
Sorry for the confusion...
I was told that E11.9 means neither hypo or hyperglycemia; in other words "stable"
I thought it meant no complications (no manifestations)
-Elaine
 
Sorry for the confusion...
I was told that E11.9 means neither hypo or hyperglycemia; in other words "stable"
I thought it meant no complications (no manifestations)
-Elaine

E11.9 is the code for diabetes without any complications. That is correct. You wouldn't use E11.9 if hypoglycemia or hyperglycemia were documented, because you'd use the more specific code for E11.65 or E11.64X. You also wouldn't code E11.9 if using any other diabetic manifiestation code, for example neuropathy or PAD.

The manifestations that fall under the "with" heading have an assumed linkage to the diabetes. The provider does not need to specifically link them to code the diabetic complication. You'd code the complication code unless the provider specifically stated that the condition was NOT related to diabetes.

This link has some information about the causal relationships of DM and also some example scenarios:

 
E11.9 is the code for diabetes without any complications. That is correct. You wouldn't use E11.9 if hypoglycemia or hyperglycemia were documented, because you'd use the more specific code for E11.65 or E11.64X. You also wouldn't code E11.9 if using any other diabetic manifiestation code, for example neuropathy or PAD.

The manifestations that fall under the "with" heading have an assumed linkage to the diabetes. The provider does not need to specifically link them to code the diabetic complication. You'd code the complication code unless the provider specifically stated that the condition was NOT related to diabetes.

This link has some information about the causal relationships of DM and also some example scenarios:

Hello! What if the documentation states in multiple places "Type 2 diabetes mellitus without complications" and the patient also has hypertension and CKD? Would you still code E11.22? Or, E11.9?
 
Hello! What if the documentation states in multiple places "Type 2 diabetes mellitus without complications" and the patient also has hypertension and CKD? Would you still code E11.22? Or, E11.9?

I would still code the E11.22 unless the provider had very clearly stated that the CKD was not related to the diabetes.

Also, I would probably bring it up to my physician for documentation improvement going forward.
 
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