Wiki Diabetes coding??

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supur38

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Hi everyone,
I am auditing some ophthalmology charts and have come across one that showed under CC/HPI: "borderline DM" for several years...it was coded 249.00 for those years. Then, in 2008, the chart showed "diabetes" under HPI and was coded 250.00.

First of all, shouldn't 'borderline' be treated the same as a 'rule out' situation and as such, should NOT be given a definitive diagnosis? This patient may never have developed DM, yet he has been labeled as having it years before it was actually confirmed.

Secondly, the patient has no diabetic retinopathy, no problems whatsoever related to his diabetes. His visit is purely to check his vision due to presbyopia which he has had for years. On the most current encounter, the doctor linked the DM code, 250.00, to his E/M charge, but then linked the charge for progressive lenses (V2781GA) to Presbyopia, 367.4.
Is that normal for ophthalmology coding?

I would really appreciate input on these questions...I just want to be sure I have a complete understanding here before moving forward!

Thanks in advance!

Susan
 
Hi Susan,

So, the first part of your question- diabetes diagnosis. To use a 249 code for borderline diabetes is wrong because the 249 code is for secondary diabetes, which might be like a drug induced situation, not borderline. The appropriate code for borderline diabetes is 790.29. Once they were classified as a diabetic, then it would be appropriate to use a 250 code.

As far as the diagnosis codes for the exam and glasses, yes, it is normal to use a medical diagnosis for an exam but then a refractive diagnosis for the eyeglasses. The reason for this is because the diagnosis for the exam is what qualifies the medical necessity of the visit- it is medically necessary for a diabetic to have their eyes examined to make sure their diabetes is not affecting thier eye health. Then for the glasses, you have to ask why are the glasses needed- if a diagnosis for diabetes was used for the eyeglasses, that would not be appropriate because that's not why they need glasses. They need glasses because of presbyopia. So the second scenerio is correct- it is normal to see different diagnosis for an exam and glasses, but sometimes you will see a refractive diagnosis for both which is also appropriate.
 
Denise, you are fantastic! Thank you so much for clearing this up for me. I made a poor 'assumption' that borderline would be treated the same as a 'rule out' scenario. My fault...thank you so, so much!

Susan
 
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