ICD10 Coding and Diabetes

Welcome to CMS eHealth. By October 1, 2015, the new ICDcoding system will beplace for both diagnosesand inpatient procedures. Using ICD10, s willcapture much more information, meaning they can betterunderstand important details about a patient's healththan with ICD9. The new codes reflecthow health care has changed over the past 30 years with manyadvancesal practice.

You'll notice updates,including definition changes, terminology changes,and a lot more specifics. The most obvious change is thatthe code structure has expanded. While the old codes havethree to five characters, the new codes have up to seven, allowing for more detaileddescriptions. The first three charactersrepresent the egory of disease or health condition,followed by a decimal point.

The fourth, fifth,and sixth characters represent al details,such as the cause of the disease, its severity,and its anatomical loion. Let's look at how this all worksusing the example of diabetes. ICD9 has two major egoriesof diabetes codes, diabetes and secondary diabetes, but ICD10 separates Type 1diabetes from Type 2 diabetes. ICD10 also eliminates the broadegory of secondary diabetes,

instead offeringsecondary options, such as underlyingconditions or causes. To capture more details,subegories can be added to represent both compliionsand affected body systems. For example, the diabetessubegories include ketoacidosis,kidney compliions, ophthalmic compliions,neurological compliions, and circulatory compliions.

Let's say a patient has diabetesdue to an underlying condition. That's code E08,followed by a decimal point. Next come the detailsin the form of subegories, starting with the fourth digit. Ketoacidosis, for example,has a fourth digit of 1. To add even more detail,a fifth digit of zero is ketoacidosis without coma, and a fifth digit of oneis ketoacidosis with coma.

These subegoriesstay the same, no matter what type of diabetesis being described. For example, diagnosis code .621 describes the compliionof foot ulcer. So E10.621 is type 1 diabeteswith foot ulcer, and E11.621 is type 2 diabeteswith foot ulcer. In this example,the provider has documented the egory of diabetesand the compliions.

Process of Elimination for ICD9 Medical Coding Part 2

What about Combo codes? When you're dealingwith ICD9, you are going to see combo codes meaning, two codes to explain the one diseaseprocess or what's going on. That's kind of like up here where we had acuteand chronic. Let's say our person had acute cholecystitis with cholelithiasis thatword right now just means they have a stone. I may not repeat that word because I'm justgoing to say stone because that's a hard word to say. So, 574 is the basic egory forhaving a stone and that's a stonethe gallbladder, not a stonethe kidneys. Don'tget that confused or anything. That's common to have stonesthe gallbladder.

So, you have to break this down, you can'tjust use 574, it tells you, you need more digits, plus we don't just have stones inthe gallbladder, we have inflammation of the gallbladder with stone. So, 574.00 we gota calculus or a stone of the gallbladder with acute cholecystitis without mention of obstruction.So, see how they've got that broken down? We've got 574, okay we got a stone and weknow it'sthe gallbladder. Now, is it acute? Yes, it's acute and our person has inflammation,their gallbladder is inflamed. Okay, well, is that stone pushing and blocking, not allowingthe gallbladder to work properly? If it is, that means it's got an obstruction so thereforeyou're going to use 574.01; and if it didn't,

then it would be (.00). Again, you don't have to have that memorized,but as a coder you need to know the process and this is where your anatomy terminologyand physiology comes in. That you need to know that if a person has an inflamed gallbladder,why they have an inflamed gallbladder? Is it because they have a stone? If it's becausethey have a stone, is it acute? Is that stone blocking anything? Those are the things youneed to know. And so, these codes break down and tell you, my person has an inflamed gallbladder,they have a stone and it does not statethis statement right here that there is anobstruction. If it doesn't state there is

an obstruction, it has to state quot;with obstructionquot;for you to be able to use 574.01; that's a guideline. So you know that your code is goingto be 574.00. I'm just kind of explaining these codes andthen I'm going to show you how you're going to be able to break those down and make quickpicks here just a little bit. So that's a combo code concept. What about dual coding?Again, like the other one, do I have to use more than one code? Now, up here for thislate effect, 438.11 it explains it all. We've got two separate conditions but we got onecode that explains it. Same thing with the respiratory failure, one code explains twoconditions.

Dual Coding really comes more with manifestations,and nothingICD10 for eduion is easier to explain guidelinesdiabetic codes soI'm constantly referring back to diabetes codes because just about every ICD9 guidelinesin a way you come back to diabetes. So, our patient has diabetic neuropathy. The codefor diabetic neuropathy is 357.2, but you just can't code 357.2. When you go look up357.2, it tells you code first the underlying disease, and249.6 is a diabetic code meaningsomething happened that made them diabetic for a short time. But 250.6 is a regular diabeticcode that means they're diabetic. The basic diabetic code is 250.00, that's a defaultcode for diabetes. If your doesn't

tell you what type of diabetes that your patienthas, the default is 250.00 because 98% of all diabetics are type 2 diabetics and that'sacceptable to use that, unless you're told that it is type 1 or type 2. So now we know. The 250.61 is diabetes type 1 because thelast digit right here is going to tell whether it's a type 1 or type 2, and if it's controlledor uncontrolled. Now, just jumping ahead real quick it has to state uncontrolled for youto. the word has to be there for you to actually use that code. But right now, we'vegot diabetic neuropathy 357.2 we can't use it by itself because this guideline righthere with that code told us we're not allowed