Type 2 Diabetes: Key coding considerations

April 20, 2015

While most physicians may use only one or two codes, it is important to code properly to reflect the condition accurately and ensure appropriate reimbursement

Diabetes Mellitus is complicated and difficult to manage, let alone bill for. While most physicians may use only one or two codes, it is important to code properly to reflect the condition accurately and ensure appropriate reimbursement. Most current codes for diabetes mellitus start with 250, with the fourth digit explaining if there are any complications and the fifth digit stating whether the condition is controlled.

In order to ensure accurate diabetes coding, it is important to:

Confirm the type of diabetes.

For type 1 the options are 250.X1 or 250.X3 based upon control, and for type 2 diabetes it is 250.X0 or 250.X2 based upon control. Other forms of diabetes, such as secondary diabetes (249) have other codes that should be used.

Determine if the diabetes is uncontrolled.

If so, the codes are 250.X2 for type 2 or 250.X3 for type 1 diabetes. In general in our practice, we are using an A1c >8% to define uncontrolled due to individualization of therapy.

Determine if there are any complications.

If yes, these are listed in the 4th digit, which is often forgotten. This would include microvascular complications (retinal, nephrologic, or neurologic) or macrovascular (cardiovascular).

Remember to include a secondary diagnosis if needed.

If you have indicated a complication in the fourth column, you will need to add a secondary diagnosis explaining that complication.

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