ICD-10 Coding and Diabetes
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ICD-10 Coding and Diabetes

November 3, 2019

Welcome to CMS eHealth. By October 1, 2015, the new ICD
coding system will be in place for both diagnoses
and inpatient procedures. Using ICD-10, doctors will
capture much more information, meaning they can better
understand important details about a patient’s health
than with ICD-9. The new codes reflect
how health care has changed over the past 30 years with many
advances in clinical practice. You’ll notice updates,
including definition changes, terminology changes,
and a lot more specifics. The most obvious change is that
the code structure has expanded. While the old codes have
three to five characters, the new codes have up to seven, allowing for more detailed
descriptions. The first three characters
represent the category of disease or health condition,
followed by a decimal point. The fourth, fifth,
and sixth characters represent clinical details,
such as the cause of the disease, its severity,
and its anatomical location. Let’s look at how this all works
using the example of diabetes. ICD-9 has two major categories
of diabetes codes, diabetes and secondary diabetes, but ICD-10 separates Type 1
diabetes from Type 2 diabetes. ICD-10 also eliminates the broad
category of secondary diabetes, instead offering
secondary options, such as underlying
conditions or causes. To capture more details,
subcategories can be added to represent both complications
and affected body systems. For example, the diabetes
subcategories include ketoacidosis,
kidney complications, ophthalmic complications,
neurological complications, and circulatory complications. Let’s say a patient has diabetes
due to an underlying condition. That’s code E08,
followed by a decimal point. Next come the details
in the form of subcategories, starting with the fourth digit. Ketoacidosis, for example,
has a fourth digit of 1. To add even more detail,
a fifth digit of zero is ketoacidosis without coma, and a fifth digit of one
is ketoacidosis with coma. These subcategories
stay the same, no matter what type of diabetes
is being described. For example, diagnosis code .621 describes the complication
of foot ulcer. So E10.621 is type 1 diabetes
with foot ulcer, and E11.621 is type 2 diabetes
with foot ulcer. In this example,
the provider has documented the category of diabetes
and the complications. Use additional separate codes
for treatment with insulin and to describe the site
of the ulcer, and the coding is complete. ICD-10 allows providers
to capture more detailed information
about their patients. This, in turn, leads to
a more detailed patient history which can help to better
coordinate a patient’s care across different providers
and over time. We’re on the road to ICD-10, and now is the time
to get ready. For resources, tools,
and fact sheets, go to the CMS website
at cms.gov/icd10.

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  1. Great animated video! Thanks! Sharing it on my page https://www.facebook.com/medicalbillingandcodingonline 

  2. "Using ICD-10, doctors will capture much more information, meaning they can better understand important details about a patient's health than with ICD-9."

    This is simply NOT a logical sentence. The "data capturing" part of the visit has nothing to do with doctors understanding their patient's health better. (That is done by talking to the patient, which we already do.) I am not aware of ANY data showing that coding to a greater level of specificity equates to better care for my patient.

  3. It hasn't improved anything, if I still need to have multiple entries in my problem list for a patient with diabetes with the very common combination of proteinuria, azotemia, peripheral neuropathy, background retinopathy, and coronary artery disease. It's not more detailed if you can pretty much do a 1:1 matching of old and new diabetes codes. Give me one code that includes everything, so I can have a problem list that is less than 20 items long for a diabetic.

    All the change seems to provide very little improvement in specificity. Take multiple sclerosis: Everything from transient intranuclear ophthalmoplegia to quadripareses is all G35, just like it was all one code before.

    How about prostate cancer? Everything from a unilateral nodule with a Gleason score of 4 to a bilateral tumor with a Gleason score of 9 and mets to the spine with spinal cord compression is still C61, just like it was all one code before. All the additional complications still need additional codes, just like ICD 9. They're just different numbers, but pretty much interchangeable with the old ones.

    While this means a lot of the hand-wringing over ICD-10 is probably overplayed (except for folks like orthopedists who will actually have to code new information like right/left side), it also seems like it provides very little improvement in data management considering the amount of hassle with the changeover.

  4. Measurement of value of care – not volume – is where healthcare will be headed, will it not? The measurement of value can't be done using vague, unspecific codes from 36 years ago.

  5. I believe the bottom line is that you code to what you are treating, or the reason for the visit, lab or medication. It isn't necessary to code every manifestation of diabetes if you aren't addressing that manifestation or if it is not of clinical significance.

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