19 Feb Off
By Lynn Diorio, CCS-P, CRC
Risk Adjustment Coder
Coding for diabetes can be a daunting process. Clear and concise documentation by the provider is key in helping to ensure that the condition is captured appropriately. There are five major categories that diabetes can fall into in ICD-10: Type 1 (E10); Type 2 (E11); Diabetes due to underlying condition (E08); Drug or chemical-induced (E09); and other specified (E13).
Diabetes due to an underlying condition (E08) is never used as a primary diagnosis and is reserved for individuals who develop DM as the result of an underlying condition such as pancreatitis, malnutrition, or malignancy. It is important that the provider documents the condition that caused the DM to develop. If the conditions are not clearly linked, a query by the coder to determine the underlying cause will be necessary.
Coding for drug or chemically-induced DM (E09) requires that the provider documents the poisoning due to a drug or toxin. Any related adverse effects would also need to be documented.
The other specified DM (E13) category is rarely used in a primary care setting. This category includes DM due to genetic defects in insulin action, genetic defects of beta-cell function, and postprocedural DM. Again, it is necessary for the provider to clearly document the cause of the DM in this case.
The two most common types of DM are Type 1 (E10) and Type 2 (E11). To document for these types of DM, it is important that the type be specified. If a type is not specified, the default type is Type 2.
The degree of control must also be documented. If the statement of “DM uncontrolled” is documented with no further specificity as to what “uncontrolled” means, a query will be necessary to determine if this is hyperglycemia or hypoglycemia. It is best practice to use DM with hyperglycemia or hypoglycemia instead of “DM uncontrolled.”
If insulin is being used, it is required that insulin use be documented. This is very important in Risk Adjustment coding, as insulin use carries an HCC.
Clear and concise documentation is always the key to a coder being able to capture the highest level of specificity with any condition, and diabetes is no different.