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dx documentation for uncontrolled diabetes

SHobbs

Networker
Messages
98
Location
Columbia
Best answers
0
I am having an issue with dx 250.02, the notes do not state the diabetes is uncontrolled so I have been confirming with the providers it is uncontrolled and if so to state that in the note. I am getting some resistance on them stating 'uncontrolled' if they ran labs that came back abnormal that date, they think the results from lab documents and supports the uncontrolled dx. Am I wrong in thinking it should state uncontrolled, as the 5th digits 0 and 1 should be chosen when 'not stated as uncontrolled' ???

Any thoughts are most appreciated.
 

j-fowler57

Guru
Messages
136
Best answers
0
They have to state uncontrolled. You can't read the lab results yourself and determine. I have worked at a couple of hospitals and the doctors do the same. Slow in accepting the requirements that we need to be more specific. I politely tell them I can't assume as we all know ASSUME means ASS out of U and ME :p Good luck!!
 

stheck

Networker
Messages
30
Location
Brighton, CO
Best answers
0
I would just politely tell them that you didn't go to med school, so you can't interpret lab results. It must state uncontrolled, or not controlled. There must also be a compliance person that will have your back when enforcing these things with providers. I work a lot with Family Practice, so I see a lot of DM. I just think it is how you speak with the provider when educating them, in most circumstances they will appreciate the information. My favorite thing to tell them is, "Per coding guidelines, it has to be done this way in order to code to the highest specificity in order to receive maximum reimbursement". Usually when I throw something in there about reimbursement they jump on the bandwagon immediately!!! Even though ICD may not have anything to do with reimbursement now, Caremore, UHC, and Medicare already have programs out there that are reimbursing based on HCC's. Providers need to be aware that their documentation will significantly impact there reimbursement in the future. :)
 
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