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Wiki Diabetes with Manifestation
- Thread starter emcee101
- Start date
em2177
Expert
If none are documented then code 250.0x Diabetes Mellitus without Mention of Complication, is assigned.
mitchellde
True Blue
But the medical record states ophthalmic manifestation. Either code unspecified for the manifestation or better would be to quey to have the specific ophthalmic manifestation added. But you could not code the 250.00 since the documentation states the manifestation is present.
rmwinder
Networker
I'm an HCC coder and we've been taught that, yes, pick up the 250.50 and if the manifestation isn't stated, you don't have to code it. Your instincts are correct that the record said DM w/ ophthalmologic (sp?) manifestations - you code just that. That came up soooo many times. We had meetings and meetings and it was brought up a lot. I know the auditors said yes... I hope that's still true. 
Rhonda,
Thank you for your response. I code HCCs as well and we are still going back and forth on this issue because we cannot find any hard evidence to support our decision. We are hoping that one of these charts could be submitted for RADV (we were chosen for national selection) but that is not one of the HCCs they are targeting.
Do you have anything that I can reference to support the decision to code the DM with manifestation instead of uncomplicated DM and the lower HCC?
Thank you for your response. I code HCCs as well and we are still going back and forth on this issue because we cannot find any hard evidence to support our decision. We are hoping that one of these charts could be submitted for RADV (we were chosen for national selection) but that is not one of the HCCs they are targeting.
Do you have anything that I can reference to support the decision to code the DM with manifestation instead of uncomplicated DM and the lower HCC?
BenCrocker
Guest
Once we get to ICD-10-CM they will NEED to be queried if they don't specify the manifestation/complication. I looked at my I-10 and there is no code for Type 2 DM with Ophthalmic Manifestation, unknown type. Closest I can find is E11.39 but it has Use Additional Code to identify the manifestation so...
Correct Ben, this is also at the heart of the issue I have when coding for 250.50. It also has a "use additional code" note and if there is no manifestation noted in the medical record then it is impossible to use the additional code.
I am looking for a respectable reference that directs a coder, expecially for risk adjustment/RADV purposes, whether it is still valid to use 250.50 if you cannot code the manifestation, or if they should defer to code 250.00 when no specific manifestation is noted in the chart.
Thanks.
I am looking for a respectable reference that directs a coder, expecially for risk adjustment/RADV purposes, whether it is still valid to use 250.50 if you cannot code the manifestation, or if they should defer to code 250.00 when no specific manifestation is noted in the chart.
Thanks.
BenCrocker
Guest
Thanks again. This gives an excellent list of possible manifestations, but what I need is something that supports the decision to code or not code the higher revenue HCC/ICD-9 code for DM with ophth. manifestation instead of uncomplicated diabetes. It seems that I am chasing a unicorn apparently
BenCrocker
Guest
Query the provider is always an option.
mitchellde
True Blue
Since he documented with ophthalmic manifestation, I see no reason you could not use unspecified eye disorder / disease. Now I did not say it would get paid! I think a provider query is best but the unspecified is an option.
I appreciate your opinions, thanks again. From an HCC standpoint an unspecified code would fall off and may not support the HCC with the "MEAT" that we need. Since I work for a health plan doing retrospective chart audit/analysis I cannot query the provider. We refer to this as unecessary provider abrasion. Can't rock the boat for questions on documentation discrepancies.