The ICD-10 coding changes due to begin October 1st, 2015 will bring challenges to the field of Endocrinology and diabetes medical coding specifically.
The types of changes made with respect to diabetes coding involves definition revisions, terminology variations, and concentrated specificity. These changes are manageable with a renewed focus on documentation and the need to specify certain aspects of a diabetic diagnosis.
For example, over 35% of the code expansions are related to noting laterality. While laterality (bilateral, right, left) has been commonly expressed in patient notes, this element is now specified under coding rules and impacts coding options.
Diabetes mellitus documentation must address three distinguishing features:
Coding options are now a combination of these elements in addition to other specifics such as laterality. The American Medical Association offers this example:
“Type e.g. Type 1 or Type 2 disease, drug or chemical induces, due to underlying condition, gestational
Complications What (if any) other body systems are affected by the diabetes condition? e.g. Foot ulcer related to diabetes mellitus
Treatment Is the patient on insulin?”
Another major change to diabetic coding involves the acceptance of a diagnosis of hypoglycemia or hyperglycemia irrespective of diabetes mellitus. These conditions can also now be documented and coded in terms of causation. It should be noted that the terms “controlled” and “uncontrolled” have been eliminated as diagnostic coding options.
Finally, new terminology variations exclude the use of “secondary diabetes mellitus.” The ICD-10 now uses specific options that describe secondary conditions. ICD-10 code examples provided by the AMA:
- E08.65 Diabetes mellitus due to underlying condition with hyperglycemia
- E09.01 Drug or chemical induced diabetes mellitus with hyperosmolarity with coma
- R73.9 Transient post-procedural hyperglycemia
- R79.9 Hyperglycemia, unspecified
The ICD-10 changes and code expansions will minimize claim disruption due to miscoding once the transition has been completed and coding compliance has become the norm. The new coding concepts do require case concentration and a need to address multiple variables in order to correctly apply the combination codes. This does create the need for training and practical testing to ensure compliance, but once accomplished, the ICD-10 will be an asset to the physician and the patient.