If you want your diabetes claims to be picture perfect in 2012, then follow these three steps to avoid future denials and keep your physician’s claim on the fast track to success.
1. Select the Fourth Digit First
Begin your code selection with diagnosis family 250.xx (Diabetes mellitus). Determine the fourth digit according to the type of diabetic complication the patient has, if any.
Case: A patient presents with diabetic hypoglycemia. You should report 250.8 (Diabetes with other specified manifestations) as your first four digits. If, however, the patient presents with diabetes without any complications, your first four digits will be 250.0 (Diabetes mellitus without mention of complication)
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Take note: Diabetes patients might have more than one complication. If so, you should code only the complication most relevant to services the physician renders that day.
2. Identify the Type for Fifth Digit
The fifth digit of the diagnosis code provides the final two pieces of information on the patient’s diabetic condition: the diabetes type (I or II) and whether or not it is controlled.
To select the fifth digit, you must first know what the following ICD-9 descriptor terms mean:
- Type I — The patient’s pancreatic beta cells no longer produce insulin. People with type I diabetes must take insulin. ICD-9 descriptors also refer to type I as “juvenile type” diabetes.
- Type II — The patient’s
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