CGS BILLING SERVICE
The physician did not document the type of diabetes!
Chapter 3 ICD9 Guidelines
2. Type of diabetes mellitus not documented
If the type of diabetes mellitus is not documented in the medical record the default is type II.
5th digits in Diabetes
250.02This code should only be used if the physician states that the diabetes is “uncontrolled”.
This code should only be used if the physician states that the diabetes is “uncontrolled”.
This code is for Type II Diabetics only.
Coding the Manifestations of Diabetes
Chapter 3 Guidelines: When assigning codes for diabetes and its associated conditions,
the codes from category 250 must be sequenced first.
Coding HTNCategory 401Category 402
Talk to your physicianabout being specific
When coding hypertension it’s good to know if it is malignant or benign.
401.0Malignant hypertension: Severe high arterial blood pressure that
results in the necrosis of the kidneys and the retina.
401.1Benign: Mildly elevated arterial blood pressure.
Hypertensive Chronic Kidney Disease
Assign a code from category 403 and category 585 or 587
Hypertensive Heart and Chronic Kidney Disease
Requires 3 codes
Assign codes from combination category 404, Hypertensive Heart and chronic kidney disease, when both hypertensive kidney disease and
hypertensive heart disease are stated in the diagnosis. Assume a relationship between the hypertension and the chronic kidney disease,
whether or not the condition is so designated. Assign an additional code from category 428, to identify the type of heart failure. More than one
code may be assigned. The appropriate code from category 585 should be used.
Elevated BP should not be coded as HTN.
Elevated blood pressure: Per the guidelines, “For a statement of elevated blood pressure without further specificity, assign code 796.2, Elevated blood pressure reading without diagnosis of hypertension, rather than a code from category
Hypertension, hypertensive (arterial) (arteriolar) (crisis) (degeneration) (disease) (essential) (fluctuating) (idiopathic) (intermittent) (labile) (low renin)(orthostatic) (paroxysmal) (primary) (systemic)(uncontrolled) (vascular) 401.0 401.1 401.9
withchronic kidney disease
stage I through stage IV, or unspecified 403.00 403.10 403.90stage V or end state renal disease 403.01 403.11 403.91
heart involvment (conditions classifiable to429.0-429.3, 429.8, 429.9 due to hypertension)(see also Hypertension, Heart) 402.00 402.10 402.90
Coding CKD Category 585
There are 5 Stages of CKDChronic Kidney Disease
585.1 Some kidney damage 585.2 Equates to mild CKD
585.3 Equates to moderate CKD585.4 Equates to severe CKD
585.5 Chronic Kidney failure with a GFR value of less than 15.
585.6End Stage Renal Disease
585.6 is assigned when the provider has documented end-state-renal disease (ESRD)
If both a state of CKD and ESRD are documented, assign code 585.6 only.
Should V58.67 be used for patients with Type 1 Diabetes?
Poorly controlled diabetes is uncontrolled diabetes
Dr. Connect has seen Sally for 5 years for HTN. For the last
5 years her diagnosis is 401.9.
Is this good or bad? What should be done about it?
When is it okay to code
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