Diabetes

1
Diabetes

• Presented by
• Renee L. Antieau, CPC, CPC-H, CMM, CRS

2
Different Types of Diabetes

• Gestational - diabetes mellitus with onset or
  recognition first appearing during the second
  trimester of pregnancy and usually disappearing
  after pregnancy is terminated.

3
Different Types of Diabetes

• Insipidus Central - a metabolic disorder due to
  injury of the neurohypophyseal system, which
  results in a deficient quantity of antidiuretic
  hormone (ADH or vasopressin) being released or
  produced, resulting in failure of tubular
  reabsorption of water in the kidney

4
Different Types of Diabetes

• Insipidus, Nephrogenic - a rare congenital and
  familial form of diabetes insipidus, resulting
  from failure of the renal tubes to reabsorb
  water. There is excessive production of
  antidiuretic hormone but the tubules fail to
  respond.

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Different Types of Diabetes

• Mellitus - a broadly applied term used to denote
  a complex group of syndromes that have in common
  a disturbance in the oxidation and utilization of
  glucose, which may be secondary to malfunction of
  the beta cells of the pancreas, whose function is
  the production and release of insulin.

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Four sets of factors influence the development of
Diabetes Mellitus
Etiology

• Genetic Factors
• Heredity
• Autoimmunity
• Environmental Factors

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Typical Symptoms of Diabetes MellitusThe Three
Polys

• Polyuria - excessive excretion of urine
• Polydipsia - excessive thirst
• Polyphagia - excessive ingestion of food

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Diabetes
Type I
Type II

• Usually starts in childhood
• Requires insulin to live
• Results in eye, renal, vascular problems-usually
  starts under age 40

• May start in childhood but usually in adults
• Usually diet or oral hypoglycemic controlled may
  require insulin
• Results in eye, renal, vascular problems- usually
  starts over age 40

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Controlled vs Uncontrolled

• Used to be determined by wide variations in swing
  of fasting blood sugars.
• Now determined by hemoglobin
  A1C levels (over 6 uncontrolled 6 or
  belowcontrolled) measures long term stability of
  process of control

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Adult vs Juvenile Onset

• Type I (Juvenile)
• vs
• Type II (Adult)
• Onset was formerly used to distinguish between
  the two types of diabetes!

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Juvenile vs Adult OnsetType I (Juvenile) and
Type II (Adult)

• Type II- 90-95 or Adult onset diabetes.
• Adults have the increased aging, environmental
  factors and potential obesity.

• Type I or insulin-dependant diabetes mellitus
  (IDDM) account for 5-10 of all cases.
• Type I is associated with HLA antigens which
  cause a defect in the immune system.

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The Importance of CodingDiabetes as an
Underlying Disease!

• Diabetic persons are prone to infection, delayed
  healing and vascular disease
• Infection is thought to be due to in part to
  decreased chemotaxis of leukocytes, abnormal
  phagocyte function and diminished blood supply
  because of atherosclerotic changes in the blood
  vessels.

13
The Importance of CodingDiabetes as an
Underlying Disease!

• An impaired blood supply means a deficit in the
  protective defensive cells transported in the
  blood.

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Documentation Issues

• The documentation may state, with diabetes, but
  this does not mean the condition is due to
  diabetes. Diabetics are vulnerable to conditions
  that affect other body systems
• Renal
• Ophthalmologic
• Vascular

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When Do I Code Diabetes?

• Look for the following information in the
  documentation
• Due to Diabetes
• Caused by Diabetes
• Secondary to Diabetes
• Complicated by Diabetes
• If you are not sure or need clarification,
  check with your doctor!

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Coding Issues

• Look for key terms in
• your ICD-9
• such as Use additional code to identify
  manifestation or
• Code first the underlying disease

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Coding for Diabetes

• 250 Diabetes Mellitus
• .0 Type II NIDDM, Adult onset, uncontrolled
• .1 Type I IDDM, juvenile type, not stated at
  uncontrolled
• .2 Type II NIDDM, Adult onset, uncontrolled-.2 to
  be used even if the patient requires insulin
• .3 Type I IDDM, juvenile type, uncontrolled

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Secondary Diabetes

• Secondary Diabetes codes should not be selected
  from category 250.
• When it has been substantiated that the diabetes
  is secondary to another condition, code the
  underlying condition. i.e. Postpancreatectomy
  Diabetes, assign code 251.3 Postsurgical
  hyposinsulemia

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Look for Excludes

• 648.8 Gestational Diabetes
• 790.6 Hyperglycemia
• 790.29 Non-clinical diabetes

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Coding to the Correct Primary Code

• 250.4 Diabetes with renal manifestations
• 250.5 Diabetes with Ophthalmic manifestations
• Also code to identify manifestation
  ie nephropathy, cataract, 5th digit.

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Endocrine System
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Coding Trivia

• Can you code the following scenarios?

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Dialysis Patient

• A patient is admitted with chronic renal failure
  for dialysis. The patient history indicates that
  the patient is a non-insulin dependant diabetic
  controlled by oral drugs.
• Code this scenario..

24
Physician Office Visit

• Patient is a 59 year old male seen in the
  physicians office for episodes of dizziness. He
  is found to have an elevated blood sugar level.
  Additional testing is done that shows a minimally
  elevated blood fasting and glucose tolerance test
  results within normal range. The physicians
  documentation specifically indicates that the
  diabetes mellitus is ruled out.
• Code this scenario.

25
Diabetic Patient with Neurological Bladder
Disorders

• A 48 year old female is seen in the clinic for
  her Neurogenic bladder disorder secondary to
  diabetes. Documentation specifically indicates
  that she is insulin dependant type II diabetic.
• Code this scenario..

26
Patient with Hypertension

• A 55 year old male is admitted with hypertension
  due to hypervolemia as a direct result of his
  chronic renal failure. Patient history indicates
  that the patient is an adult onset insulin
  dependent diabetic with renal failure.
• Code this scenario

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Diabetic with Obstruction of the Bowel

• This is a clinic visit for a 28 year old male
  type II diabetic with chronic pseudo-obstruction
  of the intestine.
• Code this scenario.

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Admission with Diabetic Neuropathy

• A patient is admitted with diabetic neuropathy
  with secondary diabetes. Patient history
  identifies the patient has a previous history of
  partial pancreatectomy that has caused his
  diabetic condition.
• Code this scenario

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ER Visit for Hypoglycemic

• An insulin dependent diabetic female is seen in
  the emergency room and is diagnosed with
  hypoglycemia. The physician identifies that the
  patient has been compliant with her prescribed
  insulin dosage.
• Code this scenario..

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ER Visit for Hypoglycemic Shock

• A type II diabetic comes into the emergency room
  after an accidental overdose of insulin. The
  patient is admitted for hypoglycemic shock.
• Code this scenario..

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Questions/Comments

• Contact Renée at
• www.peinstitute.com
• or
• Renéepei_at_aol.com
• Barbara.Millas_at_med.va.gov