ICDCM vs. ICDCM: Examine the differences in diabetes coding
JustCoding News: Outpatient, July 25,
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The physician documents diabetes mellitus in the patient’s medical record. What is the ICDCM code?
Most coders can quickly come up with And if the physician only documented diabetes mellitus, that’s the correct ICDCM code. If a physician doesn’t document complications or type of diabetes, coders default to code (diabetes mellitus without mention of complications), says Jill Young, CPC, CEDC, CIMC, president of Young Medical Consulting, LLC, in East Lansing, MI. However, is not necessarily the best code to describe the patient’s actual condition.
Consider these two patients. Patient A is a type 2 diabetic with well controlled diabetes. Patient B is a type 2 diabetic with uncontrolled diabetes who also suffers from diabetes-related chronic kidney disease.
If the physician documents “diabetes mellitus” for both patients, coders would report the same code, even though the patients have very different conditions. The physician loses reimbursement on Patient B, who is sicker and requires more care, Young says.
Coding in ICDCM
When it comes to the code assignment for diabetes mellitus in ICDCM ( code series), coders identify whether the diabetes is type 1or 2 using a fifth digit, says Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM/coding for HCPro, Inc., in Danvers, Mass, and an AHIMA-approved ICDCM/PCS trainer. If the diabetes is secondary, coders choose from codes in the series.
Under series , coders will find 10 different subcategories that further define and refine the patient’s actual condition.
- , diabetes mellitus without mention of complication
- , diabetes with ketoacidosis
- , diabetes with hyperosmolarity
- , diabetes with other coma
- , diabetes with renal manifestations
- , diabetes with ophthalmic manifestations
- , diabetes with neurological manifestations
- , diabetes with peripheral circulatory disorders
- , diabetes with other specified manifestations
- , diabetes with unspecified complication
All of those codes require a fifth digit to indicate whether the diabetes is controlled or uncontrolled, type 1or type 2. The fifth digit subclassifications are:
- 0 for type 2 or unspecified type, not stated as uncontrolled
- 1 for type1I, [juvenile type], not stated as uncontrolled
- 2 for type 2 or unspecified type, uncontrolled
- 3 for type 1, [juvenile type], uncontrolled
Coders also need to note that codes , , , , and all include instructions to use an additional code to identify manifestations as diabetic. For example, if the physician documents type 2 diabetic with uncontrolled diabetes with moderate diabetes-related chronic kidney disease, coders would report two codes:
- , diabetes with renal manifestations, uncontrolled
- , chronic kidney disease, Stage III (moderate)
Those two codes provide a much clearer picture of the patient’s actual health.
Coders also would add Vto identify long-term insulin use if the physician documented it.
Coding in ICDCM
ICDCM provides coders with a much greater range of codes to choose from in the E08–E13 (Diabetes mellitus) series. As a result, providers must document additional information, such as any underlying condition that caused the diabetes or whether drugs induced the diabetes. When physicians don’t sufficiently document the information, coders end up guessing, says Susan Fenton, PhD, RHIA, assistant professor of health information management (HIM) at Texas State University in San Marco.
In ICDCM, the categories of diabetes mellitus will help identify the type of diabetes, says McCall. Those categories are:
- E08, diabetes mellitus due to underlying condition
- E09, drug or chemical induced diabetes mellitus
- E10, type 1 diabetes mellitus
- E11, type 2 diabetes mellitus
- E13, other specified diabetes mellitus
ICDCM further divides secondary diabetes into several different types, McCall says. For example, a patient may have diabetes due to a condition or a drug the patient is taking.
When it comes to type 1 and 2 diabetes, instead of falling under one category in ICDCM (), each type has its own category in ICDCM, which is a nice enhancement, McCall says.
In ICDCM, complications and manifestations will still be identified in the code series, McCall says. Coders are already used to this with ICDCM coding. In ICDCM, the fourth character identifies manifestations and complications.
Diabetes codes in ICDCM can have up to six characters. The first three characters represent the category, just as they do in ICDCM. The fourth character identifies the presence of manifestations or complications. The fifth and sixth characters identify specific types of manifestation.
ICDCM codes for diabetes are combination codes that include the etiology and the manifestations, McCall says.
Consider the patient who has type 2 uncontrolled diabetes with moderate diabetes-related chronic kidney disease. A note under the code for type 2 diabetes mellitus with diabetic chronic kidney disease instructs coders to use an additional code to identify the stage of chronic kidney disease (N–N). So coders will need two codes in ICDCM, just as they do in ICDCM.
In ICDCM, coders would report:
- E, type 2 diabetes mellitus with diabetic chronic kidney disease
- N, chronic kidney disease, stage 3 (moderate)
If the physician documents long-term insulin use, as well, coders would report Z
Documenting diabetes in ICDCM
Diabetes documentation and coding will need to include:
- Type or cause of diabetes
- Type 1
- Type 2
- Due to drugs or chemicals
- Due to underlying condition
- Other specified diabetes
- Body system complications related to diabetes, such as kidney or neurological complications
- Specific complications, such as:
- Chronic kidney disease
- Foot ulcer
- Hypoglycemia without coma
Currently, when a coder queries a physician about a patient's diabetes, the coder is probably using a preformatted query geared toward documentation requirements for ICDCM, says Donna Smith, RHIT, AHIMA-approved ICD trainer and senior consultant for 3M Health Information Systems. She recommends changing the query forms now to get physicians used to the additional information they will need to document for ICDCM.
For secondary diabetes, the documentation of the specific type of secondary diabetes will be increasingly important so that coders assign the correct category of codes, McCall says.
Differences between ICDCM and ICDCM
One striking difference in coding for diabetes in ICDCM centers on the concept of controlled or uncontrolled diabetes, McCall says. In ICDCM, coders need that information in order to select the appropriate fifth digit. However, if coders reference diabetes mellitus in the ICDCM alphabetic index, they will find that the concept of controlled or uncontrolled is coded in a different way.
“That’s how we’re going to report diabetes that is not considered controlled,” McCall says.
Oddly, though, ICDCM does not include uncontrolled as a modifying term, even though that is what coders have badgered physicians to report for years, she adds. “I think it would be fair to say it would be the same guidance as these other synonymous terms that it would be coded to the type of diabetes with hyperglycemia.”
When it comes to secondary diabetes in ICDCM due to a drug or chemical, coders will find an instruction to “code first (T36–T65) to identify drug or chemical.” Coders will find the T codes in the table of drugs and chemicals, McCall says. Coders need to code the T code first, then the diabetes code.
For example, a physician documents an initial encounter with a patient who has corticosteroid-induced diabetes mellitus without complications. In ICDCM, coders would report:
- Tx5A, adverse effect of glucocorticoids and synthetic analogues, initial encounter
- E, drug or chemical induced diabetes mellitus without complications
The diabetes is coded as an adverse effect of a corticosteroid, McCall says. This could have some impact for inpatient coders. Traditionally when a patient is admitted for secondary diabetes, coders report the secondary diabetes code first, as the principle reason for the admission. The ICDCM guidelines to code the drug or chemical first could affect MS-DRG selection, McCall says.
When it comes to looking at the guidelines, coders need to be aware of an instructional note that McCall sees as somewhat contradictory. The ICDCM guidelines instruct coders to report first for the T code for use of steroids when patients are taking appropriately but suffer an adverse event.
The Official Coding Guidelines for ICDCM added the guideline:
When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36–T50).
That seems to contradict the guideline to code the T code first instead of the diabetes code, McCall says. “I think this is one instance where there is going to have to be some additional clarification made so coders sequence these codes correctly.”
ICDCM coding example
A physician diagnoses a patient with severe nonproliferative diabetic retinopathy with macular edema due to insulin-dependent type 2 diabetes mellitus.
Although this example may look like coders will need several codes, in ICDCM, they actually need only one code to identify the diabetes and the manifestation of severe nonproliferative diabetic retinopathy, McCall says.
For this scenario, coders would report:
- E, type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
- Z, long-term use of insulin
“I think there are some great advancements with being able to give a full picture of the diabetes and the related manifestation,” McCall says. “I think the addition of the severity is also a good addition to show how ill the patients really are.”
E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at [email protected]
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- ICD 9 Diagnosis Code - Diabetes mellitus without mention of complication - Market Size, Prevalence, Incidence, Quality Outcomes, Top Hospitals & Physicians
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|Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled|
|Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled|
|Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled|
|Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled|
Hospitalizations with - Diabetes mellitus without mention of complication - as a primary diagnosis code
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Hospitalizations with - Diabetes mellitus without mention of complication - as a primary or secondary diagnosis code
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ICDCM Coding Guide™ from Unbound Medicine. Search online 72,+ ICD codes by number, disease, injury, drug, or keyword. Explore these free sample topics:
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Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
- Billable Thru Sept 30/
- Non-Billable On/After Oct 1/
- Questionable As Admission Dx
- ICDCM is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, should only be used for claims with a date of service on or before September 30, For claims with a date of service on or after October 1, , use an equivalent ICDCM code (or codes).
- /16 ICDCM E Type 2 diabetes mellitus without complications
- Abnormal metabolic state in diabetes mellitus
- Acrorenal field defect, ectodermal dysplasia, and lipoatrophic diabetes
- Brittle diabetes mellitus
- Brittle type II diabetes mellitus
- Diabetes in childbirth
- Diabetes in pregnancy
- Diabetes mellitus
- Diabetes mellitus autosomal dominant type II
- Diabetes mellitus in childbirth
- Diabetes mellitus in mother complicating pregnancy, childbirth AND/OR puerperium
- Diabetes mellitus in the puerperium - baby delivered during current episode of care
- Diabetes mellitus induced by non-steroid drugs
- Diabetes mellitus induced by non-steroid drugs without complication
- Diabetes mellitus type 2
- Diabetes mellitus type 2 in nonobese
- Diabetes mellitus type 2 in obese
- Diabetes mellitus type 2 without retinopathy
- Diabetes mellitus without complication
- Diabetes type 2
- Diabetes type 2 controlled with diet
- Diabetes type 2 on insulin
- Diabetes type 2 with hyperglycemia
- Diabetes type 2, controlled
- Diabetes type 2, uncomplicated
- Diabetes type 2, without retinopathy
- Diabetic foot exam
- Diabetic foot exam done
- Diabetic on diet only
- Diabetic on oral treatment
- Dm 2
- DM 2 controlled by diet
- DM 2 on insulin
- DM 2 w hyperglycemia
- DM 2 wo complications
- DM 2 wo diabetic retinopathy
- DM 2, controlled
- DM 2, diet controlled
- DM 2, WO retinopathy
- DM in childbirth
- DM in pregnancy
- Foot abnormality - diabetes-related
- Gestational diabetes mellitus
- Glucose tolerance test indicates diabetes mellitus
- Hyperglycemia due to type 2 diabetes mellitus
- Insulin-treated non-insulin-dependent diabetes mellitus
- Latent autoimmune diabetes mellitus in adult
- Lipodystrophy, partial, with Rieger anomaly, short stature, and insulinopenic diabetes mellitus
- Maternal diabetes postpartum (after childbirth) complication
- Maturity onset diabetes mellitus in young
- Maturity onset diabetes of youth
- Megaloblastic anemia, thiamine-responsive, with diabetes mellitus and sensorineural deafness
- Muscular atrophy, ataxia, retinitis pigmentosa, and diabetes mellitus
- Newly diagnosed diabetes
- Non-insulin dependent diabetes mellitus in nonobese
- Photomyoclonus, diabetes mellitus, deafness, nephropathy and cerebral dysfunction
- Pineal hyperplasia AND diabetes mellitus syndrome
- Postpartum (after pregnancy) diabetes
- Postpartum DM
- Preexisting diabetes mellitus during postpartum
- Preexisting diabetes mellitus in childbirth
- Preexisting diabetes mellitus in pregnancy
- Pre-existing diabetes mellitus, non-insulin-dependent
- Preexisting diabetes postpartum (after childbirth)
- Preexisting DM in childbirth
- Preexisting DM in pregnancy
- Preexisting DM, postpartum
- Pregestational diabetes with complication in pregnancy
- Pregnancy and non-insulin-dependent diabetes mellitus
- Type 2 diabetes mellitus controlled by diet
- Type II diabetes mellitus well controlled
- Type II diabetes mellitus with arthropathy
- Type II diabetes mellitus without complication
- is not usually sufficient justification for admission to an acute care hospital when used a principal diagnosis.
Code 250 icd
ICD Code: E11* – Type 2 Diabetes Mellitus
ICD-Code E11* is a non-billable ICD code used for healthcare diagnosis reimbursement of Type 2 Diabetes Mellitus. Its corresponding ICD-9 code is
ICD-9 Code Transition:
Code I10 is the diagnosis code used for Type 2 Diabetes Mellitus. It is a disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make large amounts of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should.
Other Synonyms Include:
- being very thirsty
- urinating often
- feeling very hungry or tired
- losing weight without trying
- having sores that heal slowly
- having blurry eyesight
General ICD Information
ICD (International Statistical Classification of Diseases and Related Health problems) is now on its 10th revision. ICD codes are the byproduct of that revision. This medical classification list is generated by the World Health Organization (WHO), and is used to help healthcare providers identify and code health conditions.
ICD is required for use by physicians and healthcare providers under the Health Insurance Portability & Accountability Act (HIPAA) and will replace all ICD-9 code sets.
Many more new diagnoses can be tracked using ICD than with ICD Some expanded code sets, like ICDCM, have over 70, codes.
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