ICD-10-CM Specific Coding Guidelines - Endocrine Part II
TLDRThe transcript discusses the coding of diabetes in pregnancy scenarios, emphasizing the distinction between gestational and pre-existing diabetes. It highlights the importance of following guidelines for coding, such as C4A4 and C4A3, and correctly identifying whether insulin or non-insulin injectables are used. The speaker provides tips for recognizing insulin brands and the correct sequence for coding diabetes types and management methods.
Takeaways
- 📝 The patient manages blood sugars with insulin and diet, indicating a gestational diabetes scenario.
- 🤰 A 25-year-old OB patient at 29 weeks with gestational diabetes is the focus of the coding example.
- 🔍 The subcategory 4 02 4.4 signifies a gestational diabetes scenario.
- 📈 The patient's blood sugars are normal despite using insulin and diet for management.
- 🚫 Do not code insulin in addition to subcategory 02 4.4 for gestational diabetes.
- 📚 Reference the guidelines for gestational diabetes for correct coding practices.
- 🔢 The code 0244 is used when gestational diabetes is controlled by insulin.
- 🤰 A 30-year-old pregnant patient with diabetes mellitus uses insulin, indicating pre-existing diabetes.
- 📅 At 11 weeks pregnant, the diabetes is pre-existing, not gestational, as documentation specifies.
- 📈 Sequence the codes starting with the pregnancy code (O2 4.1), followed by the diabetes code, and then the insulin code if applicable.
- 💡 For non-pregnant patients with diabetes mellitus, use the default type two (E11.9) unless specified otherwise.
Q & A
How does the patient manage her blood sugars?
-The patient uses insulin and diet to manage her blood sugars.
What is the significance of the subcategory 4 02 4.4 in the context of the transcript?
-The subcategory 4 02 4.4 indicates a gestational diabetes scenario, which is a type of diabetes that occurs during pregnancy.
What is the correct code for gestational diabetes mellitus in pregnancy controlled by insulin?
-The correct code for gestational diabetes mellitus in pregnancy controlled by insulin is O2 4.41.
Why is it incorrect to code both insulin and z79.84 for a patient with gestational diabetes?
-It is incorrect because the guideline specifies that you should not use the insulin code in addition to the subcategory for gestational diabetes. The z79.84 code should not be used with a code from 02 4.4.
How can you determine if a patient's diabetes is pre-existing or gestational?
-A patient's diabetes is considered pre-existing if it existed prior to the pregnancy, while gestational diabetes is caused by the pregnancy itself. The documentation must specifically state 'gestational diabetes' or 'pregnancy caused the diabetes' to be classified as gestational.
What is the correct sequence for coding pre-existing diabetes in pregnancy?
-The correct sequence for coding pre-existing diabetes in pregnancy is to first code the pregnancy (O2 4.1), followed by the diabetes code, and then the insulin code if applicable.
What is the default type of diabetes mellitus if the doctor does not specify type one?
-If the doctor does not specify type one, the default type of diabetes mellitus is type two.
How can you identify if a medication is an insulin?
-You can identify if a medication is an insulin by looking for common insulin brand names that typically end with 'log' or 'Lyn', such as Humalog, Novolin, or Lantus.
What is the correct code for a patient with diabetes mellitus type 2 who is on both insulin and a non-insulin injectable like Trulicity?
-The correct code for a patient with diabetes mellitus type 2 on both insulin and a non-insulin injectable like Trulicity is E11.9 (type 2 diabetes without mention of complication), Z79.4 (long-term (current) use of insulin), and Z79.85 (long-term (current) use of other injectable drugs).
What is the ICD-10 CM code for pre-existing type two diabetes mellitus in pregnancy during the first trimester?
-The ICD-10 CM code for pre-existing type two diabetes mellitus in pregnancy during the first trimester is O24.11.
What is the importance of knowing the trimester in pregnancy when coding for diabetes?
-Knowing the trimester is important because it affects the specificity of the ICD-10 CM code. The first trimester is coded as 111, and the second trimester as 112. This specificity is required for accurate documentation and billing.
Outlines
📝 Medical Coding for Gestational Diabetes
This paragraph discusses a medical coding scenario involving a patient with gestational diabetes managed through insulin and diet. The speaker guides the audience through the process of identifying the correct codes based on the patient's condition and the guidelines provided. The focus is on understanding the subcategory 4 02 4.4, which is related to gestational diabetes, and the importance of not coding insulin in addition to this subcategory.
🤰 Coding for Gestational Diabetes in Pregnancy
The speaker continues the discussion on gestational diabetes in pregnancy, emphasizing the correct coding practices. The paragraph highlights the importance of distinguishing between gestational diabetes and pre-existing diabetes, and the correct way to sequence codes for diabetes in pregnancy. The speaker also clarifies the use of codes for insulin and oral hypoglycemics, and how to apply them based on the patient's treatment regimen.
👶 Pre-existing Diabetes in Pregnancy
This section focuses on differentiating between gestational and pre-existing diabetes in pregnant patients. The speaker explains that if a patient has diabetes before pregnancy, it is considered pre-existing. The documentation must specify 'gestational diabetes' or indicate that the pregnancy caused the diabetes. The speaker also discusses the correct coding for pre-existing diabetes in early pregnancy, emphasizing the need to know the trimester for accurate coding.
📚 Applying Guidelines for Diabetes Coding
The speaker addresses the complexity of coding for diabetes, especially when it comes to differentiating between types and treatments. The paragraph emphasizes the importance of referring to guidelines, such as C4 A3 and C4 A2, to determine the correct coding practices. The speaker also provides tips on identifying insulin brands and differentiating between insulin and non-insulin injectables, like Trulicity, for accurate coding.
💡 Understanding Insulin and Non-Insulin Injectables
In this paragraph, the speaker delves into the specifics of coding for patients using both insulin and non-insulin injectables. The focus is on understanding the correct codes for insulin (z79.4) and non-insulin injectables (z79.85) and how to apply them according to the guidelines. The speaker also provides a list of common insulin brand names to help coders identify insulin use in medical documentation.
🎉 Reflecting on Diabetes Coding Principles
The speaker concludes the discussion on diabetes coding by reinforcing the principles learned. The emphasis is on the difference between gestational and pre-existing diabetes, the correct sequence of codes for pregnancy-related diabetes, and the importance of following guidelines for accurate coding. The speaker encourages the audience to review the guidelines and to use the information provided to improve their coding skills.
Mindmap
Keywords
💡Insulin
💡Gestational Diabetes
💡Pre-existing Diabetes
💡Coding
💡Blood Sugars
💡Pregnancy
💡Dietary Management
💡ICD-10 CM
💡Trimesters
💡Non-insulin Injectables
Highlights
The patient uses insulin and diet to manage blood sugars, indicating a diabetes management scenario.
A 20-year-old OB patient with gestational diabetes at 29 weeks is discussed, providing context for the coding challenge.
The importance of reading answers first for information is emphasized in the coding process.
The subcategory 4 02 4.4 indicates a gestational diabetes scenario, which is crucial for accurate coding.
Guidelines for gestational diabetes are referenced, highlighting the necessity of following specific coding rules for such cases.
Insight into how to sequence codes for gestational diabetes, emphasizing the use of insulin and diet codes.
Clarification on not coding insulin in addition to category Z79.4, which is a common mistake in coding.
The correct code for gestational diabetes managed by insulin is identified as 02 4.4 Z3 a. 29.
A 30-year-old pregnant patient with diabetes mellitus is used as an example to differentiate between gestational and pre-existing diabetes.
The distinction between gestational diabetes and pre-existing diabetes is clarified based on documentation specifics.
The proper sequencing of codes for pre-existing diabetes in pregnancy is explained, emphasizing the use of 02 4.1 and diabetes code.
The importance of identifying the correct trimester for coding pregnancy with pre-existing diabetes is discussed.
A 36-year-old male patient with diabetes mellitus is presented as an example for coding non-pregnancy diabetes management.
The default type of diabetes mellitus when not specified by a doctor is type 2, which affects coding decisions.
A method for identifying insulin use from medication names is provided, aiding in accurate coding.
Guidelines C4 A2 and C4 A3 are referenced for coding diabetes mellitus with insulin and non-insulin injectables.
The correct coding for a patient using insulin and a non-insulin injectable like Trulicity is demonstrated as code C.
The transcript concludes with advice on using guidelines repeatedly for better understanding and application in coding.
Transcripts
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