ICD-10-CM Coding for Diabetes

Tropin’s Medical Coding Made Easy

8 Feb 202122:58

EducationalLearning

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TLDRIn this informative presentation, Terri Tropin, a certified ICD-10 trainer with a Master's in Healthcare Administration Informatics, delves into the intricacies of ICD-10-CM coding for diabetes mellitus. She outlines the process of identifying the type of diabetes, its complications, additional coding requirements, and treatment medications. Tropin emphasizes the importance of not assuming patient details and following specific guidelines for coding secondary diabetes, insulin pump complications, and treatment types. Her expertise in health information technology, coupled with her practical tips for navigating the ICD-10 coding system, makes this an invaluable resource for healthcare professionals.

Takeaways

📚 The presenter, Terri Tropin, is a certified RHIA, CCSP, and an approved ICD-10 trainer with over 20 years of teaching experience in health information technology.
🧬 Diabetes mellitus is categorized into primary and secondary types, with primary types being further divided into Type 1 (E10) and Type 2 (E11).
🔑 Insulin is likened to a key that opens cell doors to allow glucose entry; essential for understanding diabetes management.
📌 ICD-10-CM coding for diabetes requires identifying the type of diabetes, any documented complications, additional codes needed, and treatments provided.
🔢 There are five categories of diabetes, including Type 1 diabetes without complications (E10), Type 2 diabetes (E11), secondary diabetes due to underlying conditions (E08), drug-induced (E09), and other specified types (E13).
🌡️ Complications are coded with specific digits: 0 for hyperosmolarity (except Type 1), 1 for ketoacidosis, 2 for kidney, 3 for ophthalmic, 4 for neurological, 5 for circulatory, 6 for other specified, 8 for unspecified, and 9 for no complications.
📝 When a physician does not specify the type of diabetes, it is默认assumed to be Type 2 if no other information is provided.
💉 Long-term use of insulin or oral hypoglycemic drugs is indicated by codes Z79.4 and Z79.84, respectively, with additional codes for other drug therapies.
🚫 It is crucial not to report more than one category of diabetes for the same patient; all codes must belong to the same category.
📚 The presenter suggests using the ICD-10 book as a study guide and offers tips on marking it up for quick reference during coding.
📚 Terri Tropin's books on coding, including those specific to ICD-10-CM, EM coding, and PCS coding, are available on Amazon.

Q & A

What is the primary purpose of the lesson presented by Terri Tropin?
-The primary purpose of the lesson is to provide an in-depth understanding of ICD-10-CM coding for diabetes mellitus, including the identification of diabetes types, complications, additional codes, and treatment medications.
What are the qualifications of Terri Tropin in the field of healthcare informatics?
-Terri Tropin has a Master's in Healthcare Administration Informatics from the University of Maryland, Global Campus, and holds RHIA and CCSP certifications. She is also an approved ICD-10 trainer.
What are the two primary types of diabetes mentioned in the lesson?
-The two primary types of diabetes mentioned are Type 1 (E10) and Type 2 (E11) diabetes mellitus.
How does insulin function in relation to glucose in the body?
-Insulin functions as a key that opens up the door in a cell to allow glucose to enter, thus facilitating the absorption of glucose by the cells.
What is the default assumption for undocumented diabetes type according to the guidelines?
-If the type of diabetes is not documented by the physician and cannot be clarified, the default assumption is that it is Type 2 diabetes.
What does the fourth digit in the ICD-10-CM code for diabetes indicate?
-The fourth digit indicates the type of complication related to diabetes, with zero representing hyperosmolarity (except for Type 1 diabetes), followed by ketoacidosis, kidney, ophthalmic, neurological, circulatory complications, and other specified or unspecified complications.
How many complications categories are there for the five types of diabetes?
-There are the same complications categories for all five types of diabetes, with parallel subdivisions and the same numbers used in each category.
What should be considered when coding for diabetes complications?
-When coding for diabetes complications, one should code for all documented complications, use separate codes for each, and ensure that all codes are from the same diabetes category for the same patient.
What are some additional codes that might be required when coding for diabetes?
-Additional codes might be required for identifying the stage of chronic kidney disease, manifestations of ophthalmic complications like diabetic glaucoma, and the site of skin complications such as foot ulcers.
How should one code for diabetes treatment involving insulin?
-For long-term use of insulin, one should use code Z79.4. It's important not to assume that a patient using insulin is a Type 1 diabetic, as some Type 2 and secondary diabetes patients also use insulin.
What tips are provided for remembering ICD-10-CM coding guidelines?
-Tips include writing notes in the ICD-10 book to jog one's memory, underlining key terms in the alphabetic index for quick reference, and noting specific guidelines or page numbers for complex coding scenarios like post pancreatectomy.

Outlines

00:00

📚 Introduction to ICD-10-CM Coding for Diabetes Mellitus

The speaker, Terri Tropin, introduces herself as a healthcare administration informatics expert with certifications in RHIA and CCSP, and as an approved ICD-10 trainer. She has extensive teaching experience and has authored books on coding. The introduction also explains the role of insulin in diabetes management, likening it to a key that allows glucose entry into cells. The speaker then outlines the process for identifying the correct ICD-10 codes for diabetes, emphasizing the importance of determining the type of diabetes, any documented complications, additional codes required, and treatments provided.

05:03

🔍 Identifying Diabetes Types and Complications in ICD-10-CM

This section delves into the specifics of coding for different types of diabetes in ICD-10-CM. It outlines the five types of diabetes, with a focus on primary diabetes types 1 (E10) and 2 (E11). The speaker explains the process of using the alphabetic index to find the correct codes and provides examples of other types of diabetes, including secondary diabetes due to underlying conditions or drugs. The segment also discusses the default assumption of type 2 diabetes when the type is not specified and the guidelines for coding complications, emphasizing the parallel structure of complication codes across diabetes categories.

10:04

📈 Detailed Complication Coding and Practice Exercises

The speaker provides a detailed explanation of the complication codes associated with diabetes, highlighting the parallel categories and additional digits that specify the type of complication. She clarifies the use of fifth digits for specifying complications like ketoacidosis, kidney issues, ophthalmic complications, and neuropathy. The segment includes a practice exercise for coding type 2 diabetes with moderate nonproliferative retinopathy and macular edema, and the correct code (E11.3311) is provided, demonstrating the comprehensive information a single code can convey.

15:08

💡 Additional Coding Requirements and Special Notes

This part of the script addresses the need for additional codes in certain diabetes cases, such as chronic kidney disease, ophthalmic complications, and skin complications. It explains the use of 'code first' and 'use additional code' notes, emphasizing the importance of following these instructions for accurate coding. The speaker also discusses special coding guidelines for secondary diabetes due to pancreatectomy and insulin pump failure, providing specific examples and practice questions to reinforce understanding.

20:09

🌟 Medication and Treatment Coding in Diabetes Management

The speaker concludes with a discussion on coding for diabetes medications and treatments. She outlines the use of codes for long-term current use of insulin, oral hypoglycemic drugs, and other drug therapies, stressing the importance of not assuming insulin use indicates type 1 diabetes. The segment provides guidelines for identifying control using insulin or oral anti-diabetic drugs and injectable non-insulin anti-diabetic drugs. The speaker also offers tips for organizing ICD-10 books for easier reference during coding and invites questions or comments through provided contact information.

Mindmap

Keywords

💡ICD-10-CM

ICD-10-CM stands for the International Classification of Diseases, 10th Revision, Clinical Modification. It is a coding system used in the United States for documenting diagnoses and procedures for medical records and billing purposes. In the video, ICD-10-CM coding is the focus for diabetes mellitus, and the speaker is an approved trainer for this coding system.

💡Diabetes Mellitus

Diabetes mellitus is a chronic disease that affects the body's ability to process glucose, which is used as a source of energy. It is characterized by high blood sugar levels over a prolonged period. In the context of the video, the speaker discusses different types of diabetes and their complications, and how to code them using ICD-10-CM.

💡Insulin

Insulin is a hormone produced by the pancreas that regulates blood sugar levels by allowing glucose to enter cells. In the video, insulin is described metaphorically as a key that opens the door to cells, facilitating the entry of glucose. Proper coding for diabetes often involves identifying the relationship between diabetes and insulin.

💡Complications

Complications in the context of diabetes mellitus refer to the secondary health issues that can arise as a result of the disease, such as kidney damage, eye problems, and nerve damage. The video emphasizes the importance of identifying and coding for these complications accurately using ICD-10-CM.

💡Coding Guidelines

Coding guidelines are the standardized rules and instructions used to determine the correct application of ICD-10-CM codes. These guidelines ensure consistency and accuracy in medical coding. In the video, the speaker refers to the guidelines multiple times to provide accurate coding examples for diabetes-related conditions.

💡Type 1 Diabetes (E10)

Type 1 diabetes, coded as E10 in ICD-10-CM, is a form of diabetes where the body does not produce insulin. It is often diagnosed in early adulthood and requires lifelong insulin therapy. The video explains how to identify and code for Type 1 diabetes and its complications.

💡Type 2 Diabetes (E11)

Type 2 diabetes, coded as E11 in ICD-10-CM, is a form of diabetes that is often associated with resistance to insulin or a reduced ability to produce insulin. It is more common than Type 1 diabetes and is often managed through lifestyle changes, oral medications, and sometimes insulin therapy. The video provides details on how to code for Type 2 diabetes and its related complications.

💡Secondary Diabetes

Secondary diabetes refers to diabetes that is caused by another condition or as a side effect of certain medications. It is coded differently than primary diabetes (Type 1 or Type 2) and includes categories such as diabetes due to underlying conditions (E08), drug or chemical-induced diabetes (E09), and other specified types (E13). The video explains the coding differences and requirements for secondary diabetes.

💡Medication and Treatment

Medication and treatment refer to the drugs and therapies used to manage diabetes mellitus. This includes insulin, oral hypoglycemic drugs, and other injectable anti-diabetic drugs. The video discusses how to code for the type of medication and treatment a patient with diabetes is receiving, which is important for ICD-10-CM coding accuracy.

💡Practice Exercises

Practice exercises are used in the video to help viewers apply the coding concepts they've learned. These exercises involve analyzing given medical scenarios and determining the correct ICD-10-CM codes for diabetes and its complications. They serve as a practical application of the coding guidelines discussed.

💡Study Guides

Study guides are resources designed to help learners understand and remember complex information, such as medical coding guidelines. In the video, the speaker mentions her own books, which serve as study guides summarizing ICD-10-CM coding rules and are available on Amazon.

Highlights

Introduction to ICD-10-CM coding for diabetes mellitus by Terri Tropin, a certified ICD-10 trainer with over 20 years of teaching experience.

Explanation of the role of insulin in diabetes, likening it to a key that opens the door for glucose to enter cells.

Identification of the five types of diabetes categories in ICD-10-CM, including primary and secondary diabetes.

Guidelines for determining the default diabetes type when the type is not documented, which is type 2 diabetes.

Description of the coding process for diabetes complications, including the use of parallel categories for different types of diabetes.

Explanation of the fourth digit in the ICD-10-CM codes that indicates the type of complication, with exceptions for type 1 diabetes.

Instructions on how to code for multiple complications of diabetes, emphasizing the importance of using codes from the same category for the same patient.

Practice example provided for coding type 2 diabetes with moderate nonproliferative retinopathy and macular edema, resulting in the code E11.3311.

Discussion on the necessity of additional codes for certain diabetes-related conditions, such as chronic kidney disease and ophthalmic complications.

Special notes on coding for secondary diabetes due to pancreatectomy and the sequence of codes to be used.

Guidelines for coding diabetes complications caused by insulin pump failure, including the use of specific codes for underdosing or overdosing.

Explanation of how to code for medications and treatments provided for diabetes, including the use of insulin and oral hypoglycemic drugs.

Advice on using additional codes to identify the stage of chronic kidney disease and manifestation of ophthalmic complications.

Recommendations for handling cases where patients use both insulin and oral medications, or injectable non-insulin anti-diabetic drugs.

Tips for remembering ICD-10 guidelines, such as writing notes in the ICD-10 book and highlighting key terms for quick reference.

Terri Tropin's offer to provide a copy of the slides and her contact information for further questions or comments.

Information on Terri Tropin's books on coding, available on Amazon, which serve as study guides summarizing coding guidelines.

Transcripts

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Related Tags

Healthcare Coding Diabetes Mellitus ICD-10-CM Terri Tropin Master Class Medical Informatics Health Information Technology Coding Guidelines Certified Trainer