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E/M - MDM

K

KoBee

Expert
Messages
455
I am getting mixed information and i want to make sure I am capturing correct level of service.

If patient has:
  • E11.65 – Type 2 diabetes mellitus with hyperglycemia
  • E11.36 – Type 2 diabetes mellitus with diabetic cataract

For MDM (E/M coding): Diabetes is generally considered one chronic illness? even if it has multiple manifestations. Do these count as two chronic conditions or one?


Appreciate feedback
 
This is a GREAT question! This is what I have found that you can look into :) :

Authoritative chronic‑condition classification tools (such as AHRQ’s Chronic Condition Indicator Refined (CCIR)) define diabetes mellitus itself as a single chronic condition, regardless of how many body systems are affected.

  • CCIR categorizes diabetes as chronic (value 1).
  • Manifestations (neuropathy, nephropathy, retinopathy, ulcers, etc.) are complications of the same underlying disease, not separate chronic diseases.
In ICD‑10‑CM, diabetes combination codes (E11.2x–E11.8x) bundle the underlying disease plus its manifestations. These do not create multiple chronic conditions — they describe one chronic condition with complications.

I really hope this helps :)
 
See pg. 4 here: https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf & here pg. 14 https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf
Number and Complexity of Problems Addressed at the Encounter
In the CPT book E/M Services Section, see the Number and Complexity of Problems Addressed at the Encounter section. "Symptoms may cluster around a specific diagnosis and each symptom is not necessarily a unique condition." and it goes on...

Agree with the above, it is counted as a single disease. What it could drive is increased elements within data and risk, depending on the encounter and documentation.
 
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