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Z79.4 Long Term Insulin Use

  1. Default Z79.4 Long Term Insulin Use
    Medical Coding Books
    Has the guidelines/description changed for Long Term Insulin Use from ICD-9 to ICD 10 to include use of long term DM medication as long term insulin use too? I have received information from several parties that CMS and plan are now including long term DM medication with the code of long term insulin use? Thank you.

  2. Default Z79.4 Code
    It is going to be interesting to see what discussion comes from your question. Diabetes comes in several different forms (E08, E09, E10, E11, & E13 [I don't know what happened to E12, but it is not a code for anything]). E10 is Type I, which is by definition Insulin Dependent Diabetes in which Insulin is the basic/primary medication for Blood Sugar control/management. It also goes by several other descriptive names, the most common of which are Juvenile Diabetes or Idiopathic Diabetes or Brittle Diabetes. Therefore, since the patients with this disorder are on Insulin primarily, the use of Z79.4 (long term/current use of Insulin) would not be indicated. However, there are other types of Diabetes which are basically secondary to some other condition, or disease, or post-procedural in origin. These are usually primarily managed by oral medications, but sometimes if the oral agents are not providing adequate Blood Sugar control, supplemental use of insulin can be instituted. It is my understanding from my ICD-10 education process that if a patient has any of the types of diabetes other than Type I (Insulin Dependent Diabetes), but are receiving insulin as an adjunct/supplement to their oral medications, then Z79.4 should be reported.

    We will see what others say.

    Respectfully submitted, Alan Pechacek, M.D.

  3. Default
    Alan, from what I've been taught, you are correct. If you use an I10 code for Type I diabetes, it's assumed the patient is using insulin and you don't need to also code the Z79.4.
    If they have other forms of diabetes and insulin is used as part of their treatment, then you have to code the Z79.4

    Also, if the type of diabetes isn't specified in the medical record, my understanding is that we are supposed to code is as Type 2 as the default.

    Tom Cheezum, O.D., CPC

  4. Default
    Quote Originally Posted by Cheezum51 View Post
    Alan, from what I've been taught, you are correct. If you use an I10 code for Type I diabetes, it's assumed the patient is using insulin and you don't need to also code the Z79.4.
    If they have other forms of diabetes and insulin is used as part of their treatment, then you have to code the Z79.4

    Also, if the type of diabetes isn't specified in the medical record, my understanding is that we are supposed to code is as Type 2 as the default.

    Tom Cheezum, O.D., CPC
    I agree, but the physicians caring for the patient really need to be specific about the type of Diabetes the patient has. If they aren't, then they should be queried. This is all about "specificity."
    Alan Pechacek, M.D.

  5. #5
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    Columbia, MO
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    Default
    I agree! The guidelines do allow the coder to default the type to type II. However I instruct all my students to query the provider to document the type on each encounter. The coder cannot code what is known from previous encounters only that which is documented on the current encounter.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Hi Trueblue,

    What is your response to the provider who says the diagnosis is concurrent, e.g. asthma, mild persistent?

  7. Default Query on using Long term Insulin
    Hi,

    I'm coding HCC/ Risk Adjustment charts, I have on chart encounter regarding Insulin.
    It says on the Medication List patient is on Insulin, then there's no documentation of DM or other conditions that the insulin should be use for.
    It is an office visit encounter.
    Question: Should I code the Long term use of Insulin (Z79.4) documented on Medication list even w/o documentation of DM or other condition on that encounter?

    Thanks.
    JAN

  8. Default Hyperglycemia
    Hi,
    It was the question raised when we are coding risk adjustment charts...

    My auditors told that they got clarification from client saying that we can code long term use of insulin even if there is no documentation of diabetes.

    We dont have documentary evidence for this case. Just they said we followed in that way.

    But it must be supported from hyperglycemia or any other condition atleast from the previous encounters to show that the patient is using insulin.

    hyperglycemia needs administration of insulin..

    Thanks..

  9. #9
    Default
    We cannot code off medication list. Insulin use or prescription has to be documented by provider. Also each chart is independent and documentation has to be supported by that chart. For auditing purpose, payer usually asks to pull one chart that supports the code.

  10. Question Where is that information?
    Quote Originally Posted by sujaya101 View Post
    We cannot code off medication list. Insulin use or prescription has to be documented by provider. Also each chart is independent and documentation has to be supported by that chart. For auditing purpose, payer usually asks to pull one chart that supports the code.
    Hi can you direct me for finding where the book says we cannot use the med list for coding long term use of insulin or hypoglycemic meds?
    Thanks!

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