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Issue #44 - February 14, 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:
Jackson, MS 2/17
Kansas City, MO 2/17
Tulsa, OK 2/20
Jackson, MS 2/20
Columbia, SC 2/20
Charleston, SC 2/20
Chesapeake, VA 2/24
Wichita, KS 2/24
San Diego, CA 2/24
Indianapolis, IN 2/24
Indianapolis, IN 2/27
Columbus, OH 2/27
San Diego, CA 2/27
Chesapeake, VA 2/27
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 are located in chapter 4, Endocrine, Nutritional, and Metabolic Diseases, in ICD-10-CM. Unlike ICD-9-CM, the codes in ICD-10-CM for diabetes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications of that body system. There are five categories for diabetes codes in ICD-10-CM:

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

As many codes as needed to identify all of the associated conditions of the patients should be assigned.

You will notice that, as with ICD-9-CM, the terms insulin dependent and non-insulin dependent are no longer part of the code set. But the terms "uncontrolled" and "not stated as uncontrolled" are no longer part of the descriptors in ICD-10-CM. Instead, the subcategories will include "with complications" and "without complications."

Important guidelines include:

Type of diabetes mellitus not documented: If the type of diabetes mellitus is not documented in the medical record the default is category E11 Type 2 diabetes mellitus. For example, if the charge ticket states "DM" then code E11.9 Type 2 diabetes mellitus without complications is the code that must be assigned. It is very important for providers to consistently document the type of diabetes in order to report the proper code(s).

Diabetes mellitus and the use of insulin: If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11- Type 2 diabetes mellitus should be assigned. Code Z79.4 Long-term (current) use of insulin should also be assigned to indicate that the patient uses insulin. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient's blood sugar under control during an encounter.

Example:
A type 2 diabetic patient that has been using Lantus for 3 months to help control his diabetes presents for a recheck. After history and examination, it is decided to have the patient continue to use the Lantus and come back in 3 months. An A1c will be performed before the next visit.

E11.9   Type 2 diabetes mellitus without complications

Z79.4   Long-term (current) use of insulin

In the Table of Drugs and Chemicals in ICD-10-CM, a new column has been added for underdosing of medications. This has lead to new guidelines regarding insulin pump malfunction.

Underdose of insulin due to insulin pump failure: An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6 Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, that specifies the type of pump malfunction, as the principal or first-listed code, followed by code T38.3X6- Underdosing of insulin and oral hypoglycemic (antidiabetic) drugs. Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.

Overdose of insulin due to insulin pump failure: The principal or first-listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be T85.6- Mechanical complication of other specified internal and external prosthetic devices, implants and grafts followed by code T38.3X1- Poisoning by insulin and oral hypoglycemic (antidiabetic) drugs, accidental (unintentional).

Example 1:
A type 1 diabetic patient is brought in the emergency department with an insulin pump breakdown, resulting in an underdose of insulin. The patient is now has diabetic ketoacidosis with coma.

T85.614A   Breakdown (mechanical) of insulin pump, initial encounter
T38.3X6A   Underdosing of insulin and oral hypoglycemic (antidiabetic) drugs, initial encounter
E10.11   Type 1 diabetes mellitus with ketoacidosis with coma

Example 2:
A type 1 diabetic patient is brought in to the emergency department with an insulin pump breakdown, resulting in an accidental overdosing of insulin. The patient is now in a hypoglycemic coma.

T85.614A   Breakdown (mechanical) of insulin pump, initial encounter
T38.3X1A   Poisoning by insulin and oral hypoglycemic (antidiabetic) drugs, accidental (unintentional), initial encounter
E10.641   Type 1 diabetes mellitus with hypoglycemia with coma

It is important to go through the ICD-10-CM Draft Official Guidelines for Coding and Reporting 2014 and concentrate on chapters that affect your practice the most. Highlight and make note of where the guidelines differ from ICD-9-CM.

In the coming issues, watch for more articles that delve into the guidelines to help ensure proper code assignment in ICD-10-CM.

IN THE NEWS

ICD-10 Coding Basics MLN Connects™ Video
CMS has released a new MLN Connects™ video on ICD-10 Coding Basics. This video provides a basic introduction to ICD-10 coding, including:

  • Similarities to and differences from ICD-9
  • ICD-10 code structure
  • Coding process and examples
    • 7th Character
    • Placeholder "x"
    • Excludes notes
    • Unspecified codes
    • External cause codes

CODING SNAPSHOT

History of present illness: 28-year-old male patient with type 2 diabetes presents with partial vision loss in both eyes. The problem has persisted for several months and has begun to interfere with his daily functioning. The patient takes insulin in the morning and evening, along with Metformin.

Examination: The patient is alert, oriented and cooperative. The best correct visual acuity of the patient's right eye is 20/80 and the left eye is 20/25. The extraocular motility examination, confrontation visual field test, and papillary examination are within normal limits in both eyes. Intraocular pressure was 15 mm Hg in both eyes. Slit lamp shows normal eyelids and conjunctiva bilaterally. Fundus exam of both eyes shows diffuse dot and blot hemorrhages with significant amounts of macular edema noted.

Assessment: Type 2 diabetic patient with moderate nonproliferative diabetic retinopathy with macular edema bilaterally.

ICD-10-CM Codes:
E11.331   Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
Z79.4   Long-term (current) use of insulin

Rationale: The combination codes for ICD-10-CM include type, body system affected, and complication. One code combines all of the patient's conditions. The documentation also states the patient is a type 2 diabetic and takes Lantus and Metformin. Under category E11, there is an instructional note that states to use an additional code to identify any insulin use.

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.

Getting a Handle on Coder Productivity
Now that we are less than a year away from implementation of ICD-10, more focus may need to be spent on evaluation of coder productivity. Management needs an idea of what assistance may be necessary come October 1, 2014. For the coding staff, a good quick way to measure productivity needs can be done with a dual coding sample. Take 15 – 20 records and have the coding staff code them in ICD-9-CM and time them. Then, have them recode the same cases in ICD-10-CM and time them. Compare the time to get an idea of where you sit today. As they get more training and more practice in the new system, this measure can be redone to see how the gap is closing. After it has been done a couple of times it can highlight a few things: 1) What coder(s) may not be understanding the new codes. There may be one or more staff that continue to fall behind in the time measure. Knowing this will give time to get them the help they need to catch up by our live date. 2) How much outside assistance or overtime may be necessary when October 1, 2014 arrives. As you continue to perform this measure as we get closer to the transition date, you will get a sense of how much of a productivity loss you will really see. This will allow you to look at ways to offset the loss (outsourcing, overtime, new hires, etc).

The more you know, the more solid information you have, the better prepared you will be for ICD-10 transition.

FEATURED RESOURCE

ICD-10 ResourceDiabetes Reference Guide
Check out the newest coding resource on diabetes mellitus to help you make the transition to the new system. These complimentary sheets can be downloaded and make great desk references for your specialty practice.

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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