Author: Keisha Wilson CCS, CPC, CRC, CPB, CPMA, AAPC Approved Instructor
Diabetes Awareness Month
November is Diabetes awareness month. On October 31, 2022, President Biden and The White House released a statement regarding how the administration wants to combat the disease. “During National Diabetes Month, my Administration continues the fight to lower the cost of lifesaving insulin for families so that no parent is forced to ration vital medication and no child needs to skip dosages because basic treatment is unaffordable”.
There are more than 37 million Americans living with diabetes of some form, Type 1, 2, gestational diabetes, or Diabetes due to an underlining condition, Drug or chemical induced. Diabetes can also cause other complications and other chronic conditions to worsen. It is important that patients are compliant with medication as well as follow the plan providers have set forth for them. Diet and exercise also play a major role in combating the disease. Patients are encouraged to work with their providers, registered dietitians, specialists, and care team while learning new and healthy eating habits, nutrition counselling, the importance of monitoring their glucose levels at home, and managing stress.
Providers’ Documentation & Diagnosis Coding
Provider documentation plays a crucial role, in the management of this chronic condition. Over the years during chart audits and provider education I have provided, Diabetes has been one diagnosis that is always poorly documented and coded for. How many of us can say we often see a provider-only document “Diabetes Mellitus or DM” in the note, with no mention of the type of diabetes? Per ICD 10 guidelines if it is not documented E11 is the default code (Type 2 Diabetes Mellitus), followed by additional codes from category Z79, long to use of insulin or oral hypoglycemic drugs, or injectable noninsulin antidiabetic. This is not always correct, often the patient may have another type of diabetes. The provider should also be queried for clarification.
It is vital to provide continuous education to providers on the importance of documenting diabetes accurately, listing the type, the medication the patient is on, how they are doing on the medication, does the patient also have other chronic conditions, and treatment. Keeping M.E.A.T (Monitoring, Evaluating, Assessing, and Treating) in mind while documenting will help documentation to be concise and accurate. Remember as of Oct 1, 2022, there have been changes to the ICD-10 guidelines for 2023 with documenting DM medication if the patient is on oral and insulin. Per ICD -10 Guidelines;
- If the patient is treated with both oral hypoglycemic drugs and insulin, both code Z79.4, Long term (current) use of insulin, and code Z79.84, Long term (current) use of oral hypoglycemic drugs, should be assigned.
- If the patient is treated with both insulin and an injectable non-insulin antidiabetic drug, assign codes Z79.4, Long term (current) use of insulin, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs.
- If the patient is treated with both oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign codes Z79.84, Long term (current) use of oral hypoglycemic drugs, and Z79.85, Long-term (current) use of injectable non-insulin antidiabetic drugs.
The presence and management of other conditions will also allow for combination codes to be utilized and selecting coding of diagnosis codes to the highest level of specificity. It is imperative that providers and coders use/report as many combination codes as necessary to capture exactly what is happening with the patient. Each code tells a story! If there are other conditions ex: chronic kidney disease, or retinopathy, don’t forget to capture the causal relation and use the appropriate combination code.
Hierarchical Condition Category (HCC)
With Risk Adjustment and HCC, capturing diagnosis to the highest level of specificity is very important for capturing and projecting treatment for the following year. Diabetes with complications (Acute vs Chronic) on the risk adjustment table may range from categories HCC 17 – 19/20 (depending on the payer).
Social Determinants of Health (SDOH)
These are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health issues with patients, and overall quality-of-life outcomes. Providers are encouraged to document any of the above factors that may be affecting the patient, and their ability to treat the patient. For example, maybe the patient has lost their job and insurance, therefore cannot afford the medication and stopped taking it, now their diabetes has exacerbated. It is important the provider documents this for continuity of care, treatment, and resources as well as capture the appropriate diagnosis Z55-Z65 codes that are applicable to the case.
Once all of the above is documented, documentation will continue to improve, and ensure effective planning to combat and reduce the disease. Providers, coders and billers should continue to stay abreast of the new guidelines and diagnosis codes AMA releases yearly on October 1, to ensure reporting of accurate diagnosis codes.
If you have any questions regarding the documentation and coding of Diabetes and other chronic conditions, would like us to conduct a chart review, or conduct provider education contact us at keisha@kwadvancedconsulting.com.
Resources:
https://www.cms.gov/files/document/fy-2023-icd-10-cm-coding-guidelines.pdf
This post hits it on the head. It is interesting now that most companies have moved to electronic medical records (EMR); selecting appropriate Billing/CPT codes would be easier. However, it can get problematic for healthcare providers to find the time to document appropriately for said codes, eventually losing out when either trying to bill insurance companies or following up on care with the patients. Organizations expect their providers to increase the number of patients seen in the day, where the plan of care for the patient ends up mismanaged to some degree, and treatment would have to be modified.
I want to add the cultural/traditional aspect of being a part of a social determinant of health. Providers have to face the challenge of providing treatment for individuals of mixed backgrounds, which ultimately affects the overall betterment of the client. Teaching patients about the dos and don’ts of diabetic care cannot be generalized to any particular group but be individualized to maintain quality care. Documentation on the teaching provided for the patient on care then needs to include cultural background information, which can be made available to other providers servicing said patient.
Thank you, David, for your fantastic feedback and insight. I am glad you felt the post hit it on the head. My goal is to continue to highlight what I see when conducting chart audits and providing education to bring awareness. Especially coming from you, a practitioner who deals with the daily struggles of patient diagnosis management and documentation, it was great to hear the issues from your perspective with what providers face.
My role as an educator is to continue to provide education for providers, other qualified healthcare professionals and IT systems, having that collaborative effort in making EMRs more efficient for providers so the burden is lessened in the documentation process and focused more on patient care.