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  1. Default
    Medical Coding Books
    It is coded as 250.00 & V58.67.

  2. #2
    Overland Park, KS
    To quote the ICD-9 guidelines,...."if the documentation does not indicate the type of diabetes, but does indicate that the patient uses insulin, the appropriate fifth digit for type II must be used." Hope this helps.

    SOURCE: ICD-9-CM Official Guidelines for Coding and Reporting, page 27
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  3. #3
    Milwaukee WI
    Default Insulin DEPENDENT = Type 1
    Insulin DEPENDENT is the same as Type 1 or Juvenile diabetes ... i.e. the patient MUST use insulin.

    F Tessa Bartels, CPC, CEMC

  4. Default
    The use of insulin does not mean that a patient is a Type I diabetic.

    "Some patients with type II diabetes mellitus are unable to control their blood sugar through diet and oral medication alone and do require insulin. If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, the appropriate fifth-digit for type II must be used. For type II patients who routinely use insulin, code V58.67, Long-term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code V58.67 should not be assigned if insulin is given temporarily to bring a type II patient's blood sugar under control during an encounter."

  5. #5
    Evansville Indiana
    Default diabetes
    I totally agree with Jules. Type II can be insulin dependent. Insulin dependent does not necessary mean Type I unless indicated by the physician as such.

  6. #6
    Columbia, MO
    That is correct Insulin dependent does not automatically make the patient a type I. the difference between a type I and Type II patient has to do with pancreatic beta cells. When pancreatic beta cells do not exist or function the patient is a type I. For a patient classified as type II the pancreatic beta do function but it is possible the patient is resistent to the insulin being secreted or the cells are not producing enough which could then make the patient insulin dependent. So the guidelines do tell us to default to type II when the physician fails to document the type.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    When the type of diabetes is not documented but does indicate that the patient uses insulin, the default is type 2. The fact that a patient is receiving insulin does not indicate that the diabetes is type 1.

  8. #8
    Milwaukee WI
    Default Definition
    From Stedman's Medical Dictionary for the Health Professions and Nursing, Illustrated, Fifth Edition:
    Insulin dependent diabetes mellitus (IDDM): Severe diabetes mellitus, often brittle, usually of abrupt onset during the first two decades of life but can develop at any age; characterized by polydipsia, polyuria, increased appetite, weight loss, low plasma insulin levels, and episodic ketoacidosis; immune-mediated destruction of pancreatic B cells; insulin therapy and dietary regulation are necessary. SYN growth-onset diabetes, juvenile-onset diabetes, Type I diabetes. (emphasis added by FTB)

    Insulin dependent = Type 1 diabetes. Insulin DEPENDENCE is NOT just use of insulin.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 07-17-2009 at 03:48 PM.

  9. Default
    If the type of diabetes mellitus is not documented in the medical record the default is type II.
    IDDM is coded as 250.00 and V58.67

  10. #10
    I agree with Tessa that IDDM is type I.

    Insulin dependent indicates they are type I, a type II that takes insulin is referred to as insulin requiring. There is a difference. Dependent means they will die without it.

    The problem is many people, doctors included, do not use the terminology correctly. So for coding purposes we have to default to type II if all they state is IDDM. I don't agree with it, and I don't like it, but it is what it is.

    Just my 2cents,

    Laura, CPC

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