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Wiki Diabetes vs Diabetes w/manifesation

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magixz@aol.com

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I'm new to HCC pre audits on Diabetes its a bit confusing and I coming across the following scenario:

Example: Dr. submits 250.00 and he also submits and documents for 250.40 with 583.2.

The DM with CKD is properly linked and supported, so should the 250.00 DM code be removed?

Help!
 
magixz@aol.com said:
I'm new to HCC pre audits on Diabetes its a bit confusing and I coming across the following scenario:

Example: Dr. submits 250.00 and he also submits and documents for 250.40 with 583.2.

The DM with CKD is properly linked and supported, so should the 250.00 DM code be removed?

Help!
Click to expand...

You are correct that in the HCC world the higher/ more specific DM w/ Renal supercedes the less specific DM code. As far as it needing to be removed, not really because the plan will only count the higher code.

As an auditor for HCC charts you will find that a lot. 250.00, then 250.42 w/ 585.3. The plan only counts the 250.42/585.3 the 250.00 is discarded by the plan.


Hope that helps.

Gail Gordon, CPC
 
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