Coding for Diabetes in Pregnancy using ICD-10-CM
Diabetes mellitus is a condition characterized by high blood sugars, either because the person does not produce enough insulin, or because the cells do not respond to the insulin that is produced. There are three main types of diabetes mellitus (DM). Type I DM occurs when the body fails to produce enough insulin, and as a result, the person is required to take insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". Type 2 DM results from insulin resistance, a condition in which cells fail to use insulin properly. Type 2 was previously referred to as non insulin-dependent diabetes mellitus (NIDDM) or "adult-onset diabetes". The third type is gestational diabetes and occurs when pregnant women without a previous diagnosis of diabetes develop high blood glucose levels.
Currently, using ICD-9-CM, if a diabetic patient becomes pregnant, a code from 648.0x Diabetes mellitus complicating pregnancy and a secondary code from category 250 Diabetes mellitus or category 249 Secondary diabetes should be assigned to identify the type of diabetes. If the diabetes is being treated with insulin, then code V58.67 Long-term (current) use of insulin should also be assigned.
If a patient develops gestational diabetes during their pregnancy, according to ICD-9-CM, a code from 648.8x Abnormal glucose tolerance is applied. Again, if insulin is used to treat gestational diabetes, code V58.67 Long-term (current) use of insulin is assigned.
There are similarities to coding in ICD-10-CM, but there is a significant difference when coding for gestational diabetes.
Using ICD-10-CM, women who are diabetic and become pregnant should be assigned a code from category O24 Diabetes mellitus in pregnancy, childbirth, and the puerperium first, followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4. This is similar to how codes are assigned currently using ICD-9-CM. There is also a code for long-term use of insulin in ICD-10-CM, Z79.4 Long-term (current) use of insulin and it should be assigned if the diabetes mellitus is being treated with insulin.
Codes for gestational diabetes are found in subcategory O24.4 Gestational diabetes mellitus. The codes under subcategory O24.4 include diet controlled and insulin controlled. If a patient with gestational diabetes is treated with both diet and insulin, only the code for insulin-controlled is required. Code Z79.4 Long-term (current) use of insulin, should not be assigned with codes from subcategory O24.4.
There is a difference between gestational diabetes and abnormal glucose tolerance in pregnancy. Careful documentation will ensure accurate coding. Abnormal glucose is assigned a code from subcategory O99.81 Abnormal glucose complicating pregnancy, childbirth, and the puerperium in ICD-10-CM.
Diabetes can complicate a pregnancy but it doesn't need to cause complications for coding, if you follow the guidelines.
IN THE NEWS
On Friday, August 24, 2012 Department of Health and Human Services (HHS) announced a final rule that included the official delay of ICD-10 from October 1, 2013 to October 1, 2014. Now is the time to get back on track with your ICD-10 plans.
CHIEF COMPLAINT: Follow-up diabetes mellitus, type 1.
SUBJECTIVE: Patient is a 34-year-old male with significant diabetic polyneuropathy. Has been using NPH and Regular insulin to maintain his blood sugars. Also reports that he regulates his blood sugars with how he feels, rarely checking his blood sugar with a glucometer.
Reports that he has been worked up extensively at hospital and was seeing an Endocrinologist at one time. His last hemoglobin A1C drawn at the end of December is 11.9. He denies alcohol or drug use and is a non-smoker. Reports he quit drinking 3 years ago.
PHYSICAL EXAMINATION: WD, WN. Slender, 34-year-old white male. VITAL SIGNS: Blood sugar 145, blood pressure 120/88, heart rate 104, respirations 16. HEENT: Normocephalic. PERRLA. EOMI. TMs pearly gray with landmarks present. Nares patent. Throat with no redness or swelling. Nontender sinuses. NECK: Supple. Full ROM. No LAD. CARDIAC: RRR. No murmurs, rubs, or gallops. RESPIRATORY: CTA. ABDOMEN: Soft, nontender. No HSM and no masses. NEURO: Significant for lower extremity numbness throughout. Monofilament test shows more than 3 regions without sensation bilaterally. Bottoms of feet appear calloused and dry. Skin is intact. Cranial nerves 2-12 grossly nonfocal. Cerebellar function intact demonstrated through RAM.
1. Diabetes mellitus, type 1, poorly controlled.
2. Significant diabetic polyneuropathy
PLAN: Diabetes mellitus type 1: The importance of proper foot care was discussed with the patient in length. I have also asked the patient to keep a log of his blood sugars for 2 weeks and return for assessment. Patient agrees to this. We may need to put in a referral to Endocrinology to get him stabilized. Hemoglobin A1C to be drawn before next appointment.
NOTE: A monofilament test is performed to assess risk of ulcer development in a diabetic patient. A standardized filament is pressed against part of the foot (usually four different regions). When the filament bends, its tip is exerting a pressure of 10 grams (therefore this monofilament is often referred to as the 10 gram monofilament). If the patient cannot feel the monofilament at certain specified sites on the foot, he or she has lost enough sensation to be at risk of developing a neuropathic ulcer.
ICD-10-CM CODES: E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
RATIONALE: In ICD-10-CM, diabetes mellitus codes are combination codes that include type, body system affected, and complications affecting that body system. Whether the diabetes is controlled or uncontrolled is not considered for code selection in ICD-10-CM. In the above scenario, only one code is necessary as it combines the type of diabetes and the complication.
ICD-10 Implementation Strategies
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
ICD-10 Team and Committees
Now that we have an official date for transition to ICD-10, many people need to get back on track. If your ICD-10 Team and committees have been on hiatus, now is the time to hold planning meetings. New committee members may need to be selected, timelines adjusted, and budgets assessed. You will want to see what has been completed and what still needs to be completed on the road to implementation.
The Coder's Roadmap to ICD-10 has now been updated to reflect the new timeline for transition to ICD-10. It maps out the steps necessary to be ready for October 1, 2014. Check it out!