Wiki DM with manifestation

[ccade315]

I work for a family practice office, and some of the doctors are using the DM code with the manifestation example 250.60 and 337.1 however the documentation only supports them treating the DM, does not even touch on the manifestation. My thoughts are the DX code should be 250.00 not 250.60,337.1. I would love some feed back on this before I "educate" the doctors.

Thank you in advance

 

[sheripeters]

Per Coding Guidelines, you code the patients complete diabetic condition as they are all chronic and not necesserally all treated at the same time. Since they are chronic and as long as the doctor has documented all the manifistations as resulting from the DM then you would code them as per the following:

The most commonly used etiology/manifestation combinations are
the codes for Diabetes mellitus, category 250. For each code under
category 250 there is a use additional code note for the manifestation
that is specific for that particular diabetic manifestation. Should a
patient have more than one manifestation of diabetes, more than one
code from category 250 may be used with as many manifestation
codes as are needed to fully describe the patient's complete diabetic
condition. The category 250 diabetes codes should be sequenced
first, followed by the manifestation codes.

If there is no documentation to connect the DM to the manifestations than we cannot assume that they are complications caused by the DM.

EXAMPLE - If the patient has both diabetes and peripheral vascular disease, how should this be coded?
A. If the documentation indicates only diabetes and peripheral vascular disease, then the documentation is 250.00 (uncomplicated type II diabetes) and 443.9 Peripheral vascular disease, unspecified. Unless the physician specifically states that the peripheral vascular disease is a complication of the diabetes, or the physician notes "diabetes with peripheral vascular disease" or similar wording, then the two diseases are considered unrelated. This is a change from the longstanding Coding Clinic advice that the physician must state the causal relationship.

 

[ccade315]

DM

Thank you for your response, but I don't know if I was clear on what I was trying to say LOL, in other notes in the past the DM with the manifestation has been documented. On this particular visit the Doctor is only addressing the DM, like refilling DM meds. That is it. but from what I get from your replay is that you would still code both the DM and the manifestation?
Thank you again for your feed back I appreciate you taking the time.

You have been helpful.