E11.69/E10.69 linkage to diabetic HTN/HLD
This question arose from our Intelligent Medical Objects/IMO menu in our eHR. I wonder if there are other Physician Advisors who have an IMO menu and will share whether this code linkage is used/approved at your institution.
The menu offers this language: 'Diabetes associated with HTN' and 'DM associated with Hyperlipidemia', and links to the codes E11.69/E10.69, depending on whether DM is Type 1 or 2.
This elevates the coding to a NEC complication, on par with diabetic nephropathy, neuropathy, retinopathy, etc. In turn, reimbursement for this HCC will increase substantially. We are a large, integrated system. Since HTN and HLD are such commonly associated dxes in DM, this may result in submission of a substantial number of these codes. We are discussing internally with Endo, and wonder if other systems using IMO have discussed this as well.
The coding is of course up to the discretion of the Provider, but our Providers do not know the code set intimately. They really depend on the menu language to guide them in the outpatient clinic. In this case, the language is completely reasonable, but the code linkage is a higher weighted HCC they do not realize they are picking.
At your institution, do Primary care providers and Endocrinology routinely elevate HTN and HLD to the level of commonly accepted diabetic Complications AND code them at the E11.69 level? Certainly diabetic dyslipidemia in insulin resistance is common. The treatment targets are intensified, but treatment targets are intensified in other conditions, such as HTN in CAD for some pts, yet we do not get reimbursed at a higher level for treating it.
This connection to a higher weighted HCC basically arose because of the menu language linking the two. We have submitted the mapping question twice to IMO, but they have not responded.
Thanks,
JGAguirre
The menu offers this language: 'Diabetes associated with HTN' and 'DM associated with Hyperlipidemia', and links to the codes E11.69/E10.69, depending on whether DM is Type 1 or 2.
This elevates the coding to a NEC complication, on par with diabetic nephropathy, neuropathy, retinopathy, etc. In turn, reimbursement for this HCC will increase substantially. We are a large, integrated system. Since HTN and HLD are such commonly associated dxes in DM, this may result in submission of a substantial number of these codes. We are discussing internally with Endo, and wonder if other systems using IMO have discussed this as well.
The coding is of course up to the discretion of the Provider, but our Providers do not know the code set intimately. They really depend on the menu language to guide them in the outpatient clinic. In this case, the language is completely reasonable, but the code linkage is a higher weighted HCC they do not realize they are picking.
At your institution, do Primary care providers and Endocrinology routinely elevate HTN and HLD to the level of commonly accepted diabetic Complications AND code them at the E11.69 level? Certainly diabetic dyslipidemia in insulin resistance is common. The treatment targets are intensified, but treatment targets are intensified in other conditions, such as HTN in CAD for some pts, yet we do not get reimbursed at a higher level for treating it.
This connection to a higher weighted HCC basically arose because of the menu language linking the two. We have submitted the mapping question twice to IMO, but they have not responded.
Thanks,
JGAguirre
Comments
I hope this helps!
James Fee, MD, CCS, CCDS
Physician Documentation and Coding
That said, I do not teach my docs to try and link HTN and DM as it "feels" like upcoding although I could defend it clinically and from a coding perspective (being an MD and CPC).
Jim Taylor, MD, CPC
Iora Health
Medical Director of Medicare Risk Operations