Wiki HELP! Diabetes coding

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nycoder

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Hi,

I'm coding in a hospital outpatient setting, I'm new to diabetes coding and I'm seeing some confusing diabetes encounters.

What is the correct way to use 250.8 Diabetes w/ other specified manifestations and 250.9 w/ unspecified complications?

As I understand it, If the MD states that a diabetic type 2 pt is having hypoglycemic events then the appropriate code would be 250.80. I understand it as no other code is needed just the 250.80 but can this code be used for hyperglycemia as well?

For example: If a pt has T2DM but also has hyperglycemia (not hypo) is it ok to use 250.80 and 790.29 (hyperglycemia)? Does "other specified manifestations" imply that it can be used with other conditions like hyperglycemia, hypercalcemia, etc.

And regarding 250.9 Diabetes with unspecified complications: Sometimes a provider will diagnose pt as DM with complications and will describe those complications, such as: pt confused about meds, dosage, language barrier, poor insight into disease, or simply not compliant with instructions. Is it ok to use 250.9 in this case or is this wrong because the MD has actually specified the complications? If it is wrong, then what would be the correct code?

Thanks to anyone who can give some insight...
 
Diagnostic Coding Advice

Hi nycoder,

My inpatient coding class was going over this last night.
A coder should never assume the relationship between diabetes and another condition unless the provider substantiates the relationship ( coders are not doctors: quote from my inpatient instructor). Also, when assigning codes in the alphabetic index with subcategory digits, you really have to depend on the Alphabetic index and conventions to guide your code selection ( always verify code in tabular).

Just to resound the important element: never assume the relationship between two conditions/diseases. If the provider doesn’t document the relationship, there is one of two problems occurring: the patient is a train wreck, or, the provider needs to document better.

If you have anyother questions on sequencing, I would consult Kevin Shields
 
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Hyperglycemic events are considered an integral part of the disease process of diabetes. Diabetes is defined by hyperglycemia, and therefore, it is not normally coded as a complication.

However, if the hyperglycemia is so severe that it is causing other complications then that would be classifiable to the condition. For instance, ketoacidosis would be coded as 250.3X. However, your garden variety episodes of hyperglycemia are considered "normal" for this disease and would not be coded.

So if the record just indicates some hyperglycemia, but no actual complications then the diabetes would just be coded as 250.0X.
 
^^Thanks to both of you! Very informative responses. This forum is great. Thanks again.
 
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