ICD-10-CM Specific Coding Guidelines - Endocrine Part II

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all right so the patient uses insulin

and diet to manage her blood sugars

a you know what I don't like the way

this looks this looks like a

zero it does look like a zero but it's

not all right

a2444 Z3 a29 B

02445

z79.4

z79.84 Z3 a. 29 c 024 . 414

z79.4 Z3

8.29 and D O2

4.41 9

z79.4

z79.84 and Z3

a29

coders do you all see

something crap in the chat what do you

see what do you see in the answers

that's why why we read the answers first

so it can give us some information

right anybody notice something in the

answers somebody's answering the

question don't answer the question yet I

want to know what you see all right so

maybe you don't see it yet but you will

but all of these have

subcategory 4 02 4.4 that means this is

a

gational

diabetes

scenario a 20 5-year-old OB patient with

gestational diabetes and 29 weeks

pregnant arrives for a routine prenatal

visit the patient's blood sugars are

normal the patient uses insulin and diet

to manage her blood sugars okay coders

somebody coded it straight away they

said we don't know what you're talking

about Mrs Jay the answer is what say

you

I guess my little clock doesn't want to

work it's okay go ahead put your answers

in the

chat all right make sure you go grab the

guideline what's the

guideline that's right somebody said I'm

about to look at it I know that's right

let me see I want

to I wish I could see um the

full you all are saying some great

things but I can't see everything if you

make short comments I can see it but not

long ones so I do apologize for

that all right so grab your guideline

tell me which guideline you

referenced

yes yes

yes good job good job good job all right

so the

guideline is going to come up on the

next page but our key wordss gestational

diabetes 29 weeks insulin and diet and

we know this is gestational diabetes

because we just studied how to identify

them and we're going to code for

gestational diabetes and this patient's

on insulin and diet not oral

hypoglycemic I got

caught let's go back I want to make sure

it's on

there nope all right

so guideline C4

A4 it's the same as that C15 point I

yeah we're going to reference the

guidelines for gestational

diabetes all right so there's some key

language in there and it tells you it

outlines if a patient is on um you know

if it tells you how to which code to

select if the patient has um gestational

diabetes and their diabetes is being

managed using insulin diet medications

Etc so this language here kind of helps

us determine how to sequence things and

so when you have gestational diabetes I

further clarified the MC G manual so if

you have an mcg manual you don't have

the green language I suggest that you

put it in because I think it clarifies

it a little more here's

why if you have

insulin you use code

0244

one4 or if the patient um diabetes is

controlled by diet and Insulin you use

that same code

the same is true for oral

hypoglycemics or diet and oral

hypoglycemics they use the same code so

I got that from this language in the

middle so they don't really code um when

a patient is using both they code the

higher of the

two when it comes to diet and insulin or

diet and

hypoglycemics so if you want to change

your language go right ahead so knowing

this language it gives us an advantage

right sort of right well if you look

below where it says codes

z79.4 that's your insulin

z79.84 and z7

9.85 should not be used with a code from

02

4.4 make sure you put the point 4 there

you do not code insulin in addition to

this Cate this

subcategory don't do

it go ahead and write it in 04 that

subcategory we're nailing this today all

right so if that's the truth we got a

lot of wrong answers

here look at b b is wrong it's coding

z79.4 for with this O2 4.4 subcategory

it's also coding

z79.84 you cannot do it the guideline

says you can't look at C wrong too it's

coding the insulin with that subcategory

and so too is

D so look at your

answer

but a is the answer but let's go ahead

and do our due diligence right yeah

let's take a look let's put our eyes on

these codes so if we go to 024

subcategory

0241 and if you look at

02445

B this is the code for gestational

diabetes militis in pregnancy controlled

by Oral

hypoglycemics this is not pertinent to

our encounter our patient patient taking

insulin so B got to go O2 4.49 found

that D gestational diabetes metis in

pregnancy unspecified control nope we

know how this diabetes is being

controlled our documentation says it's

being controlled by use of insulin so D

is incorrect as

well now O2 4.41 for this is correct

gestational diabetes metis and pregnancy

insulin controlled so we can use it so

the biggest point that I want to make if

a patient is using insulin along with

diet you only code the insulin code and

I do want to point out that there is a

diet controlled code too 0244 one0 but

you only use it if the insulin if the um

diabetes is being made managed by diet

only so B has to go D has to

go C's

going and our answer is a 02

4.4 Z3 a.

29 okay coders how you

doing you doing

good

yes I saw all those A's in there I was

so happy you know what I I don't think I

can see your answers

anymore all right good job coders let's

go ahead and let's knock this next one

out got another pregnancy a 30-year-old

11 weeks pregnant patient oh no no no

sorry forgive me select the correct

answer a 02 4.41 4 Z3

a11 b 0241 one1

e11.9

z79.4 z

38.1c

02412

e11.9

z79.4 Z3 a11 and D O2 4.41 4

e11.9 z7 9.4 Z3

a11 a 30-year-old 11 weeks pregnant

patient who has diabetes metis arrives

for a routine prenatal visit the