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Diabetes with Manifestations coding

  1. Default Diabetes with Manifestations coding
    Medical Coding Books
    Hi,
    We have a Provider who while examining a patient only discussed or reviewed the Diabetes during an office visit. The patient has Diabetes with a manifestation but he did not address nor reference the manifestation in his notes. He coded the encounter with a 250.40 diabetes II renal manifestations.
    The coders came back to him asking him to update his note to reference the manifestation as in renal manifestation is being handled by Doctor such and such and to add the renal manifation ICD9 code to the enounter.

    The Provider is refusing to since he did not mention or deal with the renal manifestation.

    Question is we cant leave the 250.40 ICD9 code on this encounter as it is incomplete without the mention of the manifestation as well as coding of the manifestation but can we actually change it back to a 250.0X code since the patient is already diagnosed with the manifestation diabetes code in prior encounters??

    Not sure what to do in this situation so any help would be greatly appreciated!!! Thanks, Jenn

  2. #2
    Location
    Columbia, MO
    Posts
    12,836
    Default
    Each encounter has to stand on its own from the documetation so without mention of the complication of the renal issue then you have no choice but to change the code to match. So I would chose the 250.0x.

    Debra A. Mitchell, MSPH, CPC-H

  3. Question Diabetes with renal manifestation
    Hi
    Some of our physician documents condition as diabetes with renal manifestation and does not specify what the manifestation is. Our coders, code this condition with only 250.40, is this correct, please give your suggestion on this.

    Sanjeeth kumar, CPC
    Last edited by Sanjith; 12-28-2010 at 12:28 AM.

  4. #4
    Default Diabetes with renal manifestation
    Hi,
    When coding Diabetes with a manifestation you should add the manisfestation. Here are some examples for renal.
    250.40 Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
    Use additional code, to identify manifestation, as:
    chronic kidney disease (585.1-585.9)
    diabetic:
    neropathy (583.81)
    nephrosis (581.81)
    intercapillary glomerulosclerosis (581.81)
    Kimmelstiel-Wilson syndrome (581.81)
    Use additional code, if applicable for associated long-term (current) insulin use (V58.67)

    KSS,CPC, Audit Specialist

  5. #5
    Location
    Columbia, MO
    Posts
    12,836
    Default
    Quote Originally Posted by Sanjith View Post
    Hi
    Some of our physician documents condition as diabetes with renal manifestation and does not specify what the manifestation is. Our coders, code this condition with only 250.40, is this correct, please give your suggestion on this.

    Sanjeeth kumar, CPC
    You cannot code 250.40 without the manifestation code. If the manifestation is not documented then there is none. Does the physician really state in the actual note that the patient has renal manifestations of their diabetes and not say anything more? If this is the case then the coders will need to send the documentation back for clarification.

    Debra A. Mitchell, MSPH, CPC-H

  6. Question
    Thanks for the reply; Our physician have documented just diabetes with renal manifestation and not the renal problem. is it appropriate to give unspecified renal complication code as additional to 250.40 in this case?

  7. Question Diabetic renal manifestation
    Is the term Diabetic renal manifestation similar to the term diabetic nephropathy? if so, when physician documents only the term Diabetic renal manifestation, no more specification on renal manifestation, can we code 250.40 and 583.81 for this. Please anyone clarify this. Thanks:
    Last edited by Sanjith; 01-05-2011 at 02:34 AM.

  8. #8
    Location
    Fayetteville, NC
    Posts
    300
    Default
    In my opinion no. If the physician does not specify the manifestation then it is the 250.0x code only. At least as far as I am concerned. And if the physician does not address the specific complication in his notes then he didn't treat it at least according to documentation rules.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  9. Default diabetes without the manifestation listed
    My question regards how the coding will hold up to the documentation during an audit. There is no guideline that states that if the manifestation isn't known, code 250.XX, so, during an audit, wouldn't we be able to defend the use of the diabetic condition code without the manifestation with that specific note as the document? How can we defend the use of 250.0X without a guideline specifically guiding us there in abscence of a stated manifestation?

  10. #10
    Location
    Columbia, MO
    Posts
    12,836
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    You cannot use the 250 code indicating a manifestion and then not code the manifestation, the codes state in the code book to "use an additional code to code the manifestation as:" xxxxxxx
    this notation does not state: "if the coder wants to" . You still need to query the provider to be more specific in the documentation.

    Debra A. Mitchell, MSPH, CPC-H

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