With the implementation of the Patient-Driven Payment Model (PDPM) fast approaching, now’s the time to prioritize your ICD-10 training, as proper diagnostic coding will become crucial to keeping your skilled nursing facility (SNF) revenue on target.
If you’re still getting comfortable with the idiosyncrasies of ICD-10, chronic and complicated conditions like diabetes can prove challenging, particularly when different presentations of the disease affect the codes you choose.
Coding accuracy and specificity will be essential. And while it’s easy to feel overwhelmed, remember — you have seven months to get up to speed. We plan to help with regular blog posts written specifically for your SNF coding staff, so be sure to stay tuned.
Today, we simplify diabetes reporting with five coding tips to streamline the way you code this condition that affects an estimated 9.4 percent of Americans, according to the CDC’s National Diabetes Statistics Report, 2017. Not surprisingly, the percentage jumps significantly in your long-term care population, with numerous studies putting the prevalence of diabetes in the range of 25 to 34 percent.
Again, it’s important to grasp PDPM’s heavy reliance on ICD-10 coding, which will be used to determine the principal reason for the Skilled Nursing Facility Prospective Payment System (SNF PPS) stay — so let’s begin our diabetes coding tutorial!
Figuring out which diabetes code to choose can seem daunting, but you can quickly narrow your code selection by bypassing three of the five diabetes categories that rarely apply in the long-term care setting:
This leaves you with two main ICD-10 categories for the two main types of diabetes:
Caution: Type 1 and Type 2 diabetes differ significantly, with Type 1 requiring a greater complexity of care. Type 2, though, is far more common, which may lead you to erroneously default to E11 out of habit. This error can undermine vital treatment of your residents with Type 1 diabetes.
Joy Dugan and Jay Shubrook, authors of International Classification of Diseases-10 Coding for Diabetes, suggest looking at the level or degree of diabetes control.
ICD-10 does not include explicit references to controlled or uncontrolled diabetes. However, the level of control is indicated as a complication in the fourth and fifth characters: EXX.64X in the case of hypoglycemia (blood sugar levels below 70 mg/dl), and EXX.65 for hyperglycemia (blood sugar levels above 130 mg/dl).
Another fourth character, 9, indicates that the condition is controlled (e.g. E10.9 (Type 1 diabetes mellitus without complications)). But using 9 “should be the exception rather than the rule,” according to Dugan and Shubrook, “given that most people with diabetes have either suboptimal control, complications, or both.”
Type 1 diabetes is understood to be insulin-dependent, and some of your residents with Type 2 diabetes may also require insulin to manage their condition. Neither E10 nor E11 include corresponding drug use instructions. You’ll want to choose from two codes:
Note: In the above code descriptions, “long term” refers to drug therapy intended for an extended period. You can report the appropriate code as soon as drug treatment begins.
The complications associated with diabetes are seemingly endless, which makes capturing them tricky. Look through your provider’s documentation for all manifestations directly caused by the diabetes (e.g., retinopathy, hearing loss, neuropathy, feet ulceration, hypertension, etc.).
Many of these conditions can be coded with the following fourth-digit E10 and E11 subdivisions:
The only exception to this sequence is E11.0- (Type 2 diabetes mellitus with hyperosmolarity), as this complication, where extremely high blood sugar levels occur without the presence of ketones, is unique to Type 2 diabetes.
To clarify the distinction between complications and comorbidities, complications of a disease are adverse events occurring after a diagnosis of the disease — and for which the disease is the underlying cause of the subsequent conditions. Comorbidities describe medical conditions that exist at the time of diagnosis or later develop in conjunction with the disease but without a direct, causal relationship.
Reporting the comorbidities that accompany the diagnosis of diabetes is important, as these add heightened risks to your residents’ health and will require more intensive care. In terms of reimbursement, with payments increasingly risk-adjusted, improved specificity of diagnosis documentation and coding will help you collect the revenue you deserve.
Common comorbidities include:
Note: Don’t overlook obesity, which goes hand in hand with Type 2 diabetes. Be sure to code BMI (body mass index), as well.
Bottom line: Report as many codes as necessary to describe all complications and associated conditions. Sequence these codes based on the reason for the encounter.
Get your team up to speed with monthly ICD-10 coaching geared to your SNF patient population in your subscription to MDS Alert. This indispensable resource, trusted by post-acute providers for nearly 20 years, will equip you with walk-through guidance to prep for all facets of the PDPM.
Also, to receive practical ICD-10 training strategies, answers to your ICD-10 coding and ICD-10-CM coding guideline questions, as well as specific examples to help you apply ICD-10 coding fundamentals, check out TCI’s ICD-10 Coding Alert.
0
