Diabetes Medical Coding
Diabetes: Diabetes is a condition in which a person has a high blood sugar (glucose) level as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to various potential medical complications.
There are many types of diabetes, the most common of which are:
Type 1 diabetes: results from the body’s failure to produce insulin, and presently requires the person to inject insulin.
Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.
Diabetes Mellitus: Codes under category 250 diabetes mellitus, identify complications/manifestation assocatied with diabetes mellitus. A fifth -digit is required for all category 250 codes to identity the type of diabetes mellitus and whether the diabetes is controlled or uncontrolled.
Fifth digits for category 250: The following are the fifth digits for the codes under category 250 are
0 – type II or unspecified type, not stated as uncontrolled
1 – type I juvenile type, not stated as uncontrolled.
2 – type II or unspecified type, uncontrolled.
3 – type I juvenile type, uncontrolled.
NOTES: Type I diabetes mellitus is also referred to as juvenile diabetes. If the type of diabetes mellitus is not documented in the medical record the default is type II.
Diabetes mellitus and the use of insulin: All type I diabetes must use insulin to replace what their bodies do not produce. However, 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 required 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 patient who routinely use insulin, code V58.67 long term [current]
Use of insulin: 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.
(250) Diabetes mellitus
(250.0) Diabetes mellitus without mention of complication
(250.1) Diabetes with ketoacidosis
(250.2) Diabetes with hyperosmolarity
(250.3) Diabetes with other coma
(250.4) Diabetes with renal manifestations
(250.5) Diabetes with ophthalmic manifestations
(250.6) Diabetes with neurological manifestations
(250.7) Diabetes with peripheral circulatory disorders
(250.8) Diabetes with other specified manifestations
(250.9) Diabetes with unspecified complication
Examples: Diabetes mellitus uncontrolled
Examples: Diabetic hypoglycemic coma
Examples: Diabetic with chronic renal menifestation
Examples: Diabetic uncontrolled with nephrosis
Code: 250.42, 581.81
Examples: Diabetic with retinopathy with insulin dependent
Code: 250.50, 362.01, V58.67
Examples: Diabetes I with peripheral neuropathy
Code: 250.61, 337.1
Examples: Diabetes I uncontrolled with hypertension- nephrosis syndrome
code: 250.43, 581.81
Examples: Diabetes with unspecified complication
Examples: Diabetic with peripheral angiopathy with insulin
Code: 250.70, 443.81, V58.67
Examples: Diabetic gastroparalysis
Code: 250.60, 536.3
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