How to Medical Code for Uncontrolled Diabetes and Diabetic Cataracts

Q: If a patient has uncontrolled diabetes and diabetic cataracts do you need to code both the uncontrolled diabetes and diabetic cataracts or just the diabetic cataracts?

A: You guys need to know the disease process and this again I am telling you but I happen to know that I’m pretty sure Schuyler, do you know this off the top of your head because this is something that is done again and again and again. This is something that gets screwed up a lot, not coded properly.

Coach Schuyler: Right. So the important thing to understand with this is that you make sure that you’re not… let you do code but there is a specific code for uncontrolled diabetes. Uncontrolled in this, you really need to query the provider for uncontrolled diabetes because there is not a direct thing. When you go to the index…
Coach Alicia: Probably years ago or in ICD-9.

Coach Schuyler: When you say diabetes and you go to uncontrolled, it refers to as hypoglycemia or hyperglycemia; so if it’s hyperglycemia it’s 1165 or E11.65 and then you have your diabetic cataract code if it’s type 2 and which is I think E11.36 or something.

Coach Jennifer: Yeah.

Coach Schuyler: So you need to query the provider because uncontrolled diabetes cannot be coded and assume that it correlates to E11.65; so you have to query the provider in this instance.
Coach Alicia: Now, look at it from a risk adjustment aspect, too. I know that diabetic cataracts, that is a chronic condition and it’s going to risk adjust at N18, whereas I’m not sure but I think diabetic hyperglycemia might risk adjust at 17. It’s either, I don’t think it’s a 19. I think it’s either 18 or 17, which means that you need to collect both of those if it’s something you’re doing for risk adjustment.

Now, I can’t remember if the uncontrolled or the hypoglycemia is a 17 because that’s for acute conditions and it may be still classified as 18. But that is an additional reason for statistical purposes so that we get paid properly. That you would want to be able to differentiate and this is not the only scenario that that would happen and there are some other things especially when you have heart conditions and things where you want to get to a higher specificity.

Again, like he said and then make sure it’s in your compliance notebook that hey we understand this and this is the policy that we have when the scenario happens. Good question.

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