Case Studies With Medical Coding

Changes have been made in the description of diabetes codes. They are no longer termed “insulin dependent” and “non-insulin dependent.” The distinction now is on the functioning of the pancreatic beta cells. The use of insulin is not a determining factor in the type of diabetes a patient has.

Type 1 = absence of pancreatic beta cells (these patients must use insulin) Type 2 = refers to lack of proper functionality of the pancreatic beta cells (may or may not use insulin)

The changes are in the 5th digit, removing the terms “insulin dependent” and “IDDM” from 5th digit 1, and “non-insulin” “NIDDM,” and “adult onset type” from 5th digits 0 and 2.

New V code also relates to diabetes: V58.67 = long-term insulin use and is assigned as an additional code and used for type 2 diabetics that take insulin as well as women with gestational diabetes.

Example: The patient is a thin 48 year old female with well controlled type 2 diabetes. She had onset about 3 years ago and was put on insulin because she was not producing enough to sustain her. She has done well on insulin and her general health is good.

She was seen in the office today with severe nausea and vomiting for the preceding 6 hours. She stated the nausea began last night with stomach pain and diarrhea, followed later by vomiting. Labs confirmed dehydration and acute viral gastroenteritis. Her blood sugar was elevated to 190 and she was advised not to take additional insulin until the vomiting and diarrhea subsided. She was given medication and instructed to call back. The coding:

276.5 dehydration
008.8 gastroenteritis, viral type
250.00 diabetes type 2, controlled
V58.67 long term (current) insulin use

The second patient had onset of gestational diabetes during pregnancy. The codes are:

648.8# diabetes, gestational, complicating pregnancy

If you are working in a medical provider’s office, be sure to tell the staff about this change so the diagnoses may be recorded and coded correctly.