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Issue #43 - January 10, 2014

AAPC ICD-10 Tips and Resources

IN THIS ISSUE

Featured Article
In the News
Coding Snapshot
ICD-10 Strategies
ICD-10 Resource


ICD-10 EDUCATION

Code Set Boot Camps:
Phoenix, AZ 1/16
Long Beach, CA 1/16
Las Vegas, NV 1/16
San Antonio, TX 1/16
Baton Rouge, LA 1/16
Oldsmar, FL 1/20
Charlotte, NC 1/20
Oldsmar, FL 1/23
Tucson, AZ 1/23
Little Rock, AR 1/23
Austin, TX 1/23
Charlotte, NC 1/23
OKC, OK 1/27
Memphis, TN 1/27
Gretna, LA 1/27
Covington, KY 1/30
Gretna, LA 1/30
VIEW ALL

Implementation Boot Camps

Anatomy & Pathophysiology Online

Code Set Training

FEATURED ARTICLE

Diabetes Mellitus Coding in ICD-10-CM
The codes for diabetes mellitus have expanded in ICD-10-CM into five categories of codes. The codes were made into combination codes that bundle in the type, the body system affected, and any complications of the body system. The five categories are as follows:

E08   Diabetes mellitus due to an underlying condition
E09   Drug or chemically induced diabetes mellitus
E10   Type 1 diabetes mellitus
E11   Type 2 diabetes mellitus
E13   Other specified diabetes mellitus

Notice that there is no unspecified diabetes mellitus code category. According to the guidelines (I.C.4.a.2), if the type of diabetes mellitus is not documented in the medical record the default is E11, Type 2 diabetes mellitus.

Example:
John comes in to the clinic for a check up on his chronic conditions. The physician documents "diabetes" as the assessment with no further specification in the note.

E11.9   Type 2 diabetes mellitus without complications

The differences from ICD-9-CM include the fact that the codes do not include "uncontrolled" and "not stated as uncontrolled" in the descriptors any longer. Instead, the codes are listed as with and without complications. The second difference is the combination of the complication into the code.

The subcategories are broken down for the complications with the body systems affected by diabetes mellitus as follows:

  • Ketoacidosis
  • Kidney complications
  • Ophthalmic complications
  • Neurological complications
  • Circulatory complications
  • Other specified complications

Definitions for the types of diabetes mellitus are located in the "Includes notes" under each DM category. Physicians and other providers should be instructed to document the type of diabetes as type 1 or type 2, when appropriate, and not insulin and non-insulin dependent as these terms are no longer used in the coding schema.

Example:
Paulette, a type 1 diabetic, comes in today for a recheck of her diabetic right heel ulcer. Upon examination, it is healing well, with the breakdown limited to the skin.

E10.621   Type 1 diabetes mellitus with foot ulcer
L97.411   Non-pressure chronic ulcer of right heal and midfoot limited to breakdown of skin

Notice that although combination codes exist, more than one code is still necessary to indicate the site, laterality, and severity of the ulcer.

Other important guidelines to take note of for diabetes mellitus:
I.C.4.a: As many codes within a particular category as are necessary to describe all of the complications of the disease may be used. They should be sequenced based on the reason for the particular encounter. Assign as many codes from categories E08–E13 as needed to identify all of the associated conditions that the patient has.

I.C.4.a.3: If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, a code from category E11 should be assigned. Code Z79.4, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin.

Example:
Mary is a type 2 diabetic that presents to the clinic. She is doing well with her diet and exercise routine. She uses Lantus at bedtime and has her diabetes under good control. She will remain on same medication regimen and come for follow-up in three months.

E11.9   Type 2 diabetes mellitus without complications
Z79.4   Long-term (current) use of insulin

If a patient is pregnant and diabetic, codes from chapter 15, Pregnancy, childbirth, and the puerperium, should be the first-listed codes. Patients who are pregnant and diabetic should have a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, assigned first followed by a code from chapter 4.

Take the time to review the guidelines and the categories that related to diabetes mellitus to familiarize yourself with the new methodology.

IN THE NEWS

CMS Announces Testing Week
CMS has released a Change Request (CR) that states it will hold a national testing week for ICD-10-CM from March 3, 2014 through March 7, 2014. The testing week was created to generate awareness and interest and instill confidence in the provider community that CMS and MACs are ready and prepared for the ICD-10 implementation. According to CMS, your MAC will announce and actively promote the testing week by posting listserv messages and posting the testing week announcement on their website. This is a great opportunity, so please make plans to take advantage of it.

CODING SNAPSHOT

Chief Complaint:
Follow-up on diabetes mellitus

Subjective: A 70-year-old female with diabetes mellitus. She has been checking her Accu-Cheks generally once a day, and they range from 82 to a high of 132. She feels well. She walks 1-2 miles most days. If the weather is bad, they go to a local mall. Otherwise they walk outside. She is a nonsmoker. Denies abdominal pain, nausea, vomiting, diarrhea, constipation, blood in her urine, blood in her stools. She checks her feet regularly.

Medications: Her diabetes medications include Humulin insulin 70/30, 44 units at breakfast and 22 units at supper. Also metformin 500 mg at supper.

Physical Examination: Vitals: Wt: 185 B/P: 142/70. When she checks it at the mall and other places, it is usually about 120/56. T: 96.5 P: 84 and regular.
General: A 70-year-old female who does not appear to be in acute distress.
HEENT: She has frontal and maxillary sinus tenderness on the right to palpation. The right TM is slightly dull.
Neck: Supple.
Heart: Clear.
Lungs: Clear.
Abdomen: Large, nontender. No swelling.

Impression: Diabetes mellitus. A1c before next visit.

ICD-10-CM Codes:
E11.9   Type 2 diabetes mellitus without complications
Z79.4   Long=term (current) use of insulin

Rationale: Although the patient is using insulin, it cannot be assumed that she is a type 1 diabetic. This example brings in two guidelines. Guideline I.C.4.a.2 states if the type of diabetes mellitus is not documented in the medical record the default is E11, Type 2 diabetes mellitus. The second is regarding the use of insulin. Guideline I.C.4.a.3 states if the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code Z79.4, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin.

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.

Testing Opportunities
As we are closing in on the transition date for ICD-10 of October 1, 2014 (yes, this year), it will be important to look at testing opportunities. Large facilities may have already begun testing wherever available. Internal testing and external testing will be necessary to ensure that your systems will be able to send ICD-10 codes on claims, as well as receive ICD-10 codes on transactions and reports in your own system. External testing should be done with as many trading partners as is possible for your facility. If the practice utilizes a clearinghouse or billing service, the practice will depend on them to conduct testing on your behalf. In this case, make sure to have conversations early with these entities to understand the particulars of the testing that will occur. Internal testing will assist in finding problems on the practice end that need to be fixed prior to going live, while external testing will identify any issues that occur in the sending/receiving of the new information to another organization that need to be fixed prior to going live. Both pieces are necessary to completing the puzzle for a smooth transition.

FEATURED RESOURCE

ICD-10 FAQ
ICD-10 ResourceAAPC has created a listing of frequently asked questions regarding ICD-10, ICD-10 implementation, and how to get trained and prepared. Some questions include:

  • What can I do to prepare for ICD-10-CM?
  • What is the grace period for the use of ICD-9 codes submitted after implementation of the new ICD-10 codes?
  • What can I do to prepare for ICD-10-CM?
  • Implementation Training vs. Code Set Training
  • When should I begin comprehensive code-set training?

ICD-10 Tips and Resources is offered as a benefit to AAPC members and we hope you find the information useful. If you'd rather not receive future issues of ICD-10 Tips and Resources, please log in to your account and change your email preferences.

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