ICD-10 is upon us, and many offices are feeling anxious. Your anxiety is not unfounded. Transitioning from the 13,000 code ICD-9 system to the 68,000 code ICD-10 system is pretty intimidating. Diabetes codes have undergone some of the most significant changes, according to the American Academy of Ophthalmic Executives (AAOE). With 29 million Americans now suffering from the disease, it’s critical for physicians across specialties to correctly code the disorder. The AAO recently addressed the changes to diabetes coding. Consider some of their insight and tips for coding diabetes with ICD-10.
ICD-10 is very specific, going beyond the general diabetic terms used in ICD-9, such as “controlled” or “uncontrolled, or “adult-onset” or “juvenile-onset.” Now, the codes are based on a system that first identifies the type of diabetes mellitus (DM), the system in the body that is affected and the complication affecting that body system. Physicians will need to be aware of their verbiage when charting or dictating patient conditions. First, start by identifying type 1 or type 2 DM. The two are usually distinguished by the use of insulin. However, clarification may be required from an endocrinologist since insulin is sometimes used by type 2 DM patients. Insulin is coded separately from DM, using code Z79.4.
Multiple Codes Have Become One
Once type 1 or type 2 diabetes has been identified, added subcategories will help identify how the diabetes is manifesting itself in the body. Let’s break it down a little more. For ophthalmologists that previously recorded a patient’s diabetic condition using three codes, you will now use one combined code. You’ll focus on three factors:
- Type of diabetes
- The existence, type and severity of retinopathy
- The existence of macular edema
Here’s how that coding should go:
- E10.9: Type 1 diabetes mellitus without complications
- E10.349: Type 1 diabetes mellitus with severe non-proliferative diabetic retinopathy, without macular edema
- E11.321: Type 2 diabetes mellitus with mild non-proliferative diabetic retinopathy, with macular edema
- E11.351: Type 2 diabetes mellitus with proliferative diabetic retinopathy, with macular edema
There are also subcategories for complications such as neuropathic arthopathy, dermatitis, foot or skin ulcer, periodontal disease, and hypo-and hyperglycemia. Basically, use as many subcategory codes as you need to fully describe all the complications the patient has from diabetes. The new specificity of the coding system eliminates the need for the instructional notes section that was part of ICD-9. Everything you need to note or describe must be coded. For example, ICD-9 would have required a fifth code to indicate “inadequately controlled,” “poorly controlled,” or “out of control.” Instead, now a patient with uncontrolled DM would receive a code of E11.65 to indicate diabetes mellitus with hyperglycemia.
Be Sure to Distinguish Left and Right
While very specific, ICD-10 codes do not distinguish between right and left. Since diabetes disorders do not always affect one side of the body, physicians must include laterality in their coding. Here are two examples: A patient with type 1 DM with a foot ulcer would require the code E10.621. However, the physician would need to specify the site of the ulcer by adding a prefix code of L97.4 or L97.5. An ophthalmologist seeing a patient with type 1 DM with non-proliferative mild retinopathy without macular edema in the right eye and proliferative retinopathy with macular edema in the left eye would need to code each eye separately, RT-E10.329 for the right eye and LT-E10.351 for the left eye.
Type 2 Coding Identifies the Cause
We touched on this slightly, but it deserves emphasis. Under ICD-9, physicians simply coded a type 2 diabetic with the code 250, indicating DM. Under ICD-10, however, doctors must be specific about what is causing the type 2 diabetes. Here’s what we mean. Note that E12 does not exist.
- E08 identifies diabetes due to an underlying condition. This code includes DM caused by congenital rubella, Cushing’s syndrome, cystic fibrosis, malignant neoplasm, pancreatitis, even malnutrition
- E09 refers to drug or chemical induced diabetes. Codes from chapters T36 to T65 will help you identify the drug or chemical that caused the DM
- E10 is used for Type 1 DM
- E11 is used for Type 2 DM
- E13 includes other causes, such as genetic factors, and post-surgical or post-pancreatectomy causes
There is a Silver Lining
While ICD-10 seems daunting, the added specificity of the system will provide better reporting, research, public health statistics, and most importantly, patient outcomes. The ICD-10 system works hand-in-hand with the groups of quality measures found within the Physician Quality Reporting System (PQRS). Physicians can more accurately report relationships between diagnosis, manifestation and treatment. While providing better care is ultimately the greatest benefit, medical practices will benefit operationally as well. The new codes pave a more detailed electronic trail, resulting in greater payment accuracy from government institutions like Medicare, as well as insurers.
Advantage Administration, Inc. specializes in helping medical practices reach optimal financial and operational efficiency. A smooth transition to ICD-10 is just one piece of an efficient practice management strategy. Find out more about how our practice assessment can help your office through some of the biggest changes health care has seen in decades. For more information on ICD-10 implementation and available resources, contact our billing and collections team at Agnite Health LLC at 844.318.2150.
Use of this diagnosis reference document and the information presented (collectively, the “Materials”) is subject to these terms and conditions. By possessing, accessing or using the Materials, you acknowledge reading and agree to these terms and conditions. The Materials are maintained and provided by Advantage Administration, Inc. (“Advantage’) and Agnite Health LLC (“Agnite”) as a courtesy. Medical coding is a complex process involving continually changing rules and the application of judgment to factual situations. The Materials are (a) intended for use as a general reference tool only, and not as a substitute for legal advice, accounting advice, and independent judgment and analysis by qualified coding personnel; and (b) provided “as is” without representation or warranty of any kind — as to suitability, reliability, applicability, merchantability, fitness, noninfringement, result, outcome, or any other matter. Although Advantage and Agnite attempts to provide reasonably current and accurate information, neither Advantage nor Agnite, nor its employees, affiliates, agents or representatives (“Advantage and Agnite Parties”) represent or warrant such matters, or that any public or private payer or third-party will agree with the information presented. You should not assume or rely on the fact that the Materials are current, complete, or accurate. Any representation or warranty that might be otherwise implied is expressly disclaimed. By using the Materials, you agree (a) that Advantage and Agnite and the Advantage and Agnite Parties shall not be liable to you or any third party, in any way or for any damages of any kind or under any theory, arising from the Materials; any errors in or omissions from the information presented; or your access to or use of or reliance on the Materials, including but not limited to liability or damages under contract, tort or other legal theories; and (b) to fully and finally release, indemnify, defend and hold harmless Advantage and Agnite and Advantage and Agnite Parties from all claims or liabilities arising from your use of the Materials.