melissalynnfalkowski
Networker
I work for an endocrinologist who is on some sites with peers that have told her that they bill all type 1 dm pump patients a level 5 based on a few things.
PART1
They are using the codes and counting them in their # of dx and treatment options. If you are coding Dm with hypo/hyperglycemia or any other DM dx for that matter, would it be appropriate to count these towards the # of dx and treatment options?
Z96.41
Presence of insulin pump (external) (internal)
Z79.4
Long term (current) use of insulin
Z46.81
Encounter for fitting and adjustment of insulin pump
PART2
They are also stating that a diabetic type 1 on a pump either cgm or other with documented highs and lows would qualify for high risk based on "drug therapy requiring intensive monitoring"
Every argument my endocrinologist gave me seemed legitimate. I mean these patients can slip into comas and there is a ton of risk
I see the drug table only lists IV insulin as inclusive of this but it could be argued that a patient on a CGM/pump isn't IV but requires same monitoring?
I know the list isn't all inclusive but just wondering your thoughts?
PART1
They are using the codes and counting them in their # of dx and treatment options. If you are coding Dm with hypo/hyperglycemia or any other DM dx for that matter, would it be appropriate to count these towards the # of dx and treatment options?
Z96.41
Presence of insulin pump (external) (internal)
Z79.4
Long term (current) use of insulin
Z46.81
Encounter for fitting and adjustment of insulin pump
PART2
They are also stating that a diabetic type 1 on a pump either cgm or other with documented highs and lows would qualify for high risk based on "drug therapy requiring intensive monitoring"
Every argument my endocrinologist gave me seemed legitimate. I mean these patients can slip into comas and there is a ton of risk
I see the drug table only lists IV insulin as inclusive of this but it could be argued that a patient on a CGM/pump isn't IV but requires same monitoring?
I know the list isn't all inclusive but just wondering your thoughts?