Diabetes Criteria

kelley.huff@wjmc.orgkelley.huff@wjmc.org
in CDI Talk Archive
We recently did education to our hospitalist group regarding the documentation needs for diabetes currently and what is expected to come for ICD-10. We had the same question repeatedly asked wanting to know if there is any criteria they can follow to guide them when documenting the control of a pateints' diabetes. I usually instruct the physicians to use thier judgement but they were not satisfied with this. Does anyone know of any guidelines that are used to determine the control of a patients' diabetes for the ICD-9 terms(controlled/uncontrolled) as well as the ICD-10 terms(out of control/inadequately controlled/poorly controlled)? I am going to do some research but wanted other CDIS opinions.

Thanks.

Kelley Huff, RN, BSN, CCM
Clinical Documentation Specialist
West Jefferson Medical Center
504-349-1874
kelley.huff@wjmc.org

Comments

  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited April 2016
    Kelley,
    First, I would see what guidelines the endocrinologists at the hospital use.

    Kathleen Benson RN, BSN, CCDS
    Supervisor, Clinical Documentation Integrity
    University of Wisconsin Hospital
    608-890-5935
    kbenson@uwhealth.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    On its most basic level we look for multiple BGL >200 (without other established cause) and/or an A1C>7.

    That being said, am I correct in my understanding that I-10 will not allow for the differentiation between controlled/uncontrolled DM? We are trying to focus in on MD's making the connection between DM and diabetic complications in an effort to prepare for I-10... Also minor differences in guidelines like that there will no longer be an assumed connection between Diabetes and osteomyelitis (as far as I know).

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • ssalinasssalinas
    edited April 2016
    I believe if the DM is described as uncontrolled, poorly controlled, inadequate control or with hypoglycemia, it can still be coded but I-10 uses different terminology.

    If uncontrolled, poorly controlled, inadequate control is documented, DM with hyperglycemia is coded.
    E11.65 describes DM2 with hyperglycemia;
    E10.65 is used for DM1 with hyperglycemia
    Same is true for DM with hypoglycemia w or w/o coma.
    DM2 with hypoglycemia is E11.64x.
    DM1 with hypoglycemia with coma is E10.641; w/o coma is E10.649.

    Any DM complications/manifestations would also be coded separately.

    At least this is how I understand it at this point in time.

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


  • ssalinasssalinas
    edited April 2016
    Sorry - below email is confusing!

    I believe if the DM is described as uncontrolled, poorly controlled, inadequate control or with hypoglycemia, it can still be coded but I-10 uses different terminology.

    If uncontrolled, poorly controlled, inadequate control is documented, DM with hyperglycemia is coded.
    E10.65 is used for DM1 with hyperglycemia
    E11.65 describes DM2 with hyperglycemia;
    Same is true for DM with hypoglycemia w or w/o coma.
    DM1 with hypoglycemia with coma is E10.641; w/o coma is E10.649.
    DM2 with hypoglycemia is E11.64x.

    Any DM complications/manifestations would also be coded separately.

    At least this is how I understand it at this point in time.

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    So even if they just say 'poorly controlled' we can code DM with hyperglycemia? The MD does not need to say 'hyperglycemia'?

    Thanks Sharon!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


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