ICD-10-CM Specific Coding Guidelines - Endocrine Part III

AMCI Medical Coding

15 Feb 202434:00

EducationalLearning

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TLDRThe transcript is an engaging educational session focused on medical coding for diabetes-related conditions. It guides through various scenarios, emphasizing the importance of following guidelines for coding secondary diabetes, especially when due to underlying conditions like pancreatitis or Cushing syndrome. The session highlights the correct sequence for coding these conditions, the necessity of referring to the instructional notes, and the process of identifying and coding the primary and secondary diagnoses, including the proper handling of temporary insulin use and insulin pump malfunctions.

Takeaways

📝 The transcript discusses coding guidelines for diabetes mellitus, specifically focusing on type 2 diabetes with diabetic neuropathy due to acute pancreatitis.
🩺 The patient in the scenario is not insulin-dependent but is temporarily on insulin for blood sugar control.
🧾 Coders are instructed to follow the C4A6 guideline for secondary diabetes and to prioritize the instructional notes for accurate coding.
🔍 The coding process involves identifying the primary condition (acute pancreatitis) and the secondary condition (diabetes mellitus with neuropathy).
📈 The correct code sequence for the scenario is K85.90 (acute pancreatitis without necrosis or infection, unspecified) followed by E8.4 (diabetes mellitus due to underlying condition with neuropathy).
🚫 Temporary insulin use is not coded, as per the guidelines.
📝 Another scenario involves a patient with type 1 diabetes experiencing hypoglycemia due to an insulin pump malfunction.
🧩 The correct coding for the type 1 diabetes scenario involves T85.6 (insulin pump failure), T38.3x1 (overdose of insulin), E10 (type 1 diabetes), and any associated complications.
📌 General coding guidelines highlight that conditions integral to a disease process are not coded separately, and signs and symptoms (R codes) are not necessary if a specific diagnosis is present.
🔑 For type 1 diabetes, insulin codes are not added separately as it is understood that patients are taking insulin.
📈 A final scenario discusses a patient with diabetes mellitus and CKD stage 3 due to Cushing syndrome, emphasizing the importance of following instructional notes and using the correct sequencing order for coding.

Q & A

What type of diabetes was the 40-year-old patient diagnosed with?
-The 40-year-old patient was diagnosed with diabetes mellitus type 2 and diabetic neuropathy due to acute pancreatitis.
Is the patient with type 2 diabetes insulin-dependent?
-No, the patient is not insulin-dependent but is temporarily on insulin to control blood sugar levels.
Which guideline should be used for coding the patient's condition?
-The guideline to be used for coding the patient's condition is C4A6 for secondary diabetes.
What is the importance of following instructional notes when coding secondary diabetes?
-Following instructional notes is crucial because they provide the correct sequencing order and guidance on how to code specific conditions, ensuring accurate and compliant documentation.
How is the code for diabetes mellitus with neuropathy due to acute pancreatitis structured?
-The code is structured as a combination code, including the type of diabetes and the neuropathy. For example, E8.4 is the default code for diabetes mellitus with neuropathy due to an underlying condition.
What is the correct code for acute pancreatitis without necrosis or infection, unspecified?
-The correct code for acute pancreatitis without necrosis or infection, unspecified is K85.90.
Why is it advised not to code temporary insulin?
-Coding for temporary insulin is not advised because it is a temporary treatment and not a condition itself. The focus should be on the underlying condition that necessitates the temporary insulin use.
What was the issue with the 45-year-old patient with type one diabetes?
-The 45-year-old patient with type one diabetes experienced extreme fatigue, dizziness, and confusion due to an insulin pump malfunction that delivered a higher dose of insulin than prescribed, leading to hypoglycemia.
What are the steps to code the encounter for the type one diabetes patient with an insulin pump malfunction?
-First, identify the type of diabetes (E10 for type one), then code for the medical complication (T85.6 for insulin pump malfunction), followed by the overdose code (T38.3x1 for overdose of insulin), and finally, any associated complications.
Why is it important to know the sequencing order when coding for diabetes encounters?
-Knowing the sequencing order is important because it ensures that the codes are structured correctly in the patient's medical record, reflecting the hierarchy of conditions and treatments, which is essential for accurate billing and reporting.
How does the presence of CKD stage three due to Cushing syndrome affect the coding for a patient with diabetes mellitus?
-The presence of CKD stage three due to Cushing syndrome requires the use of secondary diabetes codes (E89), following the instructional notes for sequencing. The primary code is for Cushing syndrome (E24.9), followed by the diabetes mellitus code with CKD (E08.22), and then the code for the stage of CKD (N18.30 for unspecified stage three).

Outlines

00:00

📝 Coding Guidelines for Diabetes Management

This paragraph discusses the coding process for a 40-year-old patient with type 2 diabetes mellitus and diabetic neuropathy due to acute pancreatitis. The patient is temporarily on insulin, and the coders are guided to use the C4A6 guideline for secondary diabetes. The speaker emphasizes the importance of following instructional notes and understanding the guidelines when coding for secondary diabetes and its management.

05:00

🗂️ Sequencing Order in Coding for Secondary Diabetes

In this paragraph, the focus is on the sequencing order for coding secondary diabetes due to an underlying condition, specifically acute pancreatitis. The speaker advises coders to follow instructional notes and provides a detailed explanation of how to code for diabetes with neuropathy (E8.4) and the underlying condition (acute pancreatitis). The paragraph also clarifies that temporary insulin use should not be coded.

10:02

🚨 Handling Overdose Scenarios in Diabetes Coding

The speaker presents a scenario involving a 45-year-old patient with type one diabetes who experiences hypoglycemia due to an insulin pump malfunction. The paragraph outlines the correct coding approach for such an encounter, emphasizing the use of the overdose code (T38.3x1) and the medical complication code (T85.6). The speaker also reminds coders to follow the sequencing order as per the guidelines and to avoid coding for insulin in type one diabetes cases.

16:37

🔍 Applying Coding Guidelines for Diabetes with Complications

This paragraph delves into coding for a patient with diabetes mellitus and CKD stage three due to Cushing's syndrome. The speaker instructs coders to identify the correct guideline (C4A6) and to sequence the codes as per the instructional notes. The paragraph highlights the importance of coding the underlying condition first, followed by the diabetes code with the appropriate CKD stage.

21:39

📈 Verification and Sequencing in Medical Coding

The paragraph discusses the verification process for coding diabetes mellitus with CKD stage three due to an underlying medical condition. The speaker guides coders through the process of looking up the codes in the index and tabular list, emphasizing the need to sequence the codes correctly, starting with the underlying condition (Cushing's syndrome), followed by the diabetes code with CKD, and finally the stage of CKD.

26:41

🎯 Finalizing Codes for Diabetes with CKD and Cushing's Syndrome

In the final paragraph, the speaker wraps up the coding process for the scenario of diabetes mellitus with CKD stage three due to Cushing's syndrome. The speaker confirms the codes to be used: E24.9 for Cushing's syndrome, E8.22 for diabetes due to the underlying condition with CKD, and N18.30 for unspecified CKD stage three. The paragraph reinforces the importance of following instructional notes and the sequencing order for accurate coding.

Mindmap

Keywords

💡Diabetes Malius

Diabetes Malius, also known as diabetes mellitus, is a chronic condition that affects the body's ability to process blood sugar. In the context of the video, it is specifically mentioned as type 2, which is a form of diabetes where the body becomes resistant to insulin or doesn't produce enough insulin. The video discusses a patient diagnosed with this condition and its complications, such as diabetic neuropathy and acute pancreatitis.

💡Diabetic Neuropathy

Diabetic neuropathy is a type of nerve damage that often occurs in people with long-standing diabetes. It is caused by high sugar levels, which can injure the nerves throughout the body. In the video, this condition is attributed to acute pancreatitis, highlighting the interconnectedness of various health issues in patients with diabetes.

💡Acute Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas that can be caused by various factors, including gallstones and excessive alcohol consumption. In the video, it is mentioned as the underlying condition leading to the development of diabetes mellitus type 2 and diabetic neuropathy in the patient.

💡Insulin

Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. In the context of the video, a patient with diabetes is temporarily on insulin to control blood sugar, despite not being insulin-dependent. This highlights the treatment management for certain types of diabetes mellitus.

💡Coding Guidelines

Coding guidelines refer to the standardized rules and instructions used by medical coders to accurately document and report medical diagnoses and procedures. In the video, the emphasis is on following specific guidelines, such as C4 and A6, for coding secondary diabetes and its related conditions.

💡Secondary Diabetes

Secondary diabetes is a type of diabetes that occurs as a result of another medical condition, such as acute pancreatitis in the case discussed in the video. It is different from primary diabetes, which is not caused by another underlying condition.

💡Sequencing Order

Sequencing order refers to the specific arrangement of diagnosis and procedure codes in medical billing and reporting. The correct sequence can impact the accuracy of medical records and reimbursement. In the video, the importance of following the instructional notes and guidelines for the proper sequencing order of codes is emphasized.

💡Chronic Kidney Disease (CKD)

Chronic kidney disease, or CKD, is a long-term condition where the kidneys are damaged and cannot function properly. It is characterized by stages, with stage three indicating moderate loss of kidney function. In the video, CKD stage three is mentioned as a complication due to Cushing syndrome in a patient with diabetes mellitus.

💡Cushing Syndrome

Cushing syndrome is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. It can lead to various health issues, including the development of secondary diabetes and chronic kidney disease. In the video, Cushing syndrome is identified as the underlying medical condition causing diabetes mellitus and CKD stage three in a patient.

💡Medical Complication

A medical complication refers to an unforeseen and often harmful event that occurs during the course of a disease or medical treatment. In the video, the malfunction of an insulin pump leading to an overdose of insulin is an example of a medical complication.

Highlights

A 40-year-old patient diagnosed with diabetes mellitus type 2 and diabetic neuropathy due to acute pancreatitis.

The patient is not insulin-dependent but is temporarily on insulin to control blood sugar.

Coders are instructed to use the C4A6 guideline for secondary diabetes.

Secondary diabetes is due to an underlying condition, such as pancreatitis in this case.

The importance of following instructional notes when coding for secondary diabetes is emphasized.

The correct code for diabetes mellitus type 2 with diabetic neuropathy due to acute pancreatitis is E8.4.

For temporary insulin use, it is advised not to code it explicitly.

The code for acute pancreatitis without necrosis or infection, unspecified is K85.90.

A 45-year-old patient with type one diabetes experiences fatigue, dizziness, and confusion due to an insulin pump malfunction.

The insulin pump delivered a higher dose of insulin than prescribed, leading to hypoglycemia.

The correct code for insulin overdose due to pump failure is T38.3x1.

The sequencing order for coding this encounter is T85.6 (medical complication), T38.3x1 (overdose code), E10 (type of diabetes), and any associated complications.

Fatigue, dizziness, and confusion are integral to hypoglycemia and are not coded separately.

For type one diabetes, insulin codes are not added because it is understood that patients are taking insulin.

A patient with diabetes mellitus and CKD stage three due to Cushing syndrome is presented.

The coding for this case involves identifying the guideline for secondary diabetes due to an underlying medical condition.

The code for diabetes mellitus due to an underlying condition with CKD is E8.22.

An additional code is used to identify the stage of CKD, which is N18.9.

Cushing syndrome is coded as E24.9, which is the first code to be used in the sequence.

The final coding sequence for the patient is E24.9 (Cushing syndrome), E8.22 (diabetes mellitus with CKD), and N18.9 (CKD stage three, unspecified).

Transcripts

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Related Tags

Medical Coding Diabetes Management Secondary Diabetes Insulin Overdose Type One Diabetes Type Two Diabetes Chronic Pancreatitis Hypoglycemia Cushing Syndrome CKD Stage 3