dial-in instructions - hcpro · 2007. 1. 16. · 10:00 a.m.–11:30 a.m. (pacific) a90-minute...

Conference name: Diabetes Coding: Understand the Disease and Its Documentation Requirements

Scheduled conference date: Wednesday, January 17, 2007

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Diabetes Coding: Understand thedisease and its documentation

requirements

1:00 p.m.–2:30 p.m. (Eastern)

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11:00 a.m.–12:30 p.m. (Mountain)

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A 90-minute interactive audioconference

Wednesday, January 17, 2007

ii Diabetes Coding: Understand the disease and its documentation requirements

In our materials, we strive to provide our audience with useful and timely information. The live audioconfer-ence will follow the enclosed agenda. Occasionally, our speakers will refer to the enclosed materials. Wehave noticed that non-HCPro audioconference materials often follow the speakers’ presentations bullet-by-bullet and page-by-page. However, because our presentations are less rigid and rely more on speaker inter-action, we do not include each speaker’s entire presentation. The enclosed materials contain helpful forms,crosswalks, policies, charts, and graphs. We hope that you will find this information useful in the future.

HCPro, Inc., is not affiliated in any way with The Joint Commission on Accreditation of HealthcareOrganizations, which owns the The Joint Commission trademark.

iiiDiabetes Coding: Understand the disease and its documentation requirements

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Copyright 2007, HCPro, Inc.

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iv Diabetes Coding: Understand the disease and its documentation requirements

Dear Colleague,

Thank you for participating in our “Diabetes Coding: Understand theDisease and Its Documentation Requirements” audioconference withRobert S. Gold, MD, and Shannon McCall, RHIA, CCS, CPC, moderat-ed by Lisa Eramo. We are excited about the opportunity to interact withyou directly and encourage you to ask our experts your questions duringthe audioconference. If you would like to submit a question before theaudioconference, please send it to [email protected] and provide theprogram date in the subject line. We cannot guarantee that your questionwill be answered during the program, but we will do our best to take agood cross section of questions.

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Thanks again for working with us.

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200 Hoods Lane

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Tel: 800/650-6787

Fax: 800/639-8511

vDiabetes Coding: Understand the disease and its documentation requirements

Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi

Speaker profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Exhibit A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Presentation by Robert S. Gold, MD, and Shannon McCall, RHIA, CCS, CPC

Exhibit B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Link to the report of the Expert Committee on the Diagnosis and Classification of DiabetesMellitus and a table of Etiologic Classifications of Diabetes Mellitus

Exhibit C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Quizlet: ICD-9 Coding for Diabetes Mellitus

Exhibit D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25List of HIM “Acronyms to Know”

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Contents

vi Diabetes Coding: Understand the disease and its documentation requirements

Agenda

I. Diseases caused by diabetes versus diseases in diabetics: How to differentiate and correctly code for them

A. Reporting combination codes with manifestation codesB. Coding each individually

II. The basics of the clinical classification of all forms of diabetes and the impact on coding

A Type I diabeticB. Type II v. Type I

III. Diabetes uncontrolled and poorly controlledA. Fifth digit assignmentsB. Reporting the additional code V58.67C. Factoring “poorly controlled” or “poor control” in code assignment

when they are documented in the medical record

IV. The current status of diabetes from a coding standpoint and the future for 2008

V. Physician queries: How to get the info you need from the medical staff

VI. Selected case studies

VII. Live Q&A

viiDiabetes Coding: Understand the disease and its documentation requirements

Speaker profiles

Robert S. Gold, MD

Robert S. Gold, MD, is founder and CEO of DCBA, Inc., in Atlanta, GA, a consultingfirm that provides physician-to-physician educational programs in clinical documentationimprovement, including training staffs to perform concurrent review, and HIM profes-sionals to understand the clinical aspects of diseases and procedures to which theyassign codes. He has more than 40 years of experience as a physician, medical direc-tor, and consultant. Gold writes Clinically Speaking for Briefings on Coding

Compliance Strategies and Minute for the Medical Staff for Medical Records Briefing, and is the author ofthe new training handbook, Documentation Strategies to Support Severity of Illness: Ensure an accurate pro-fessional profile, all from HCPro.

Shannon McCall, RHIA, CCS, CPC

Shannon McCall, RHIA, CCS, CPC, is director of coding and HIM at HCPro, Inc.,where she serves as the lead instructor for two of the Certified Coder Boot Camps®,which cover physician and outpatient hospital coding and inpatient hospital facility cod-ing. As a member of HCPro, Inc.’s consulting staff, she works with hospitals, medicalpractices, and other healthcare providers on a wide range of coding-related issues witha particular focus on coding reviews and audits. McCall has extensive experience with

coding for both physician and hospital services. Prior to joining HCPro, Inc., she worked for Per-SeTechnologies, a national medical practice management company, where her duties included serving asinstructor for Per-Se’s in-house coding training and certification program.

Exhibit A

Presentation by Robert S. Gold, MD, and Shannon McCall, RHIA, CCS, CPC

EXHIBIT A

2 Diabetes Coding: Understand the disease and its documentation requirements

1

Diabetes Coding:

Understand the Disease and its

Documentation Requirements

� Shannon E. McCall, RHIA, CCS, CPC

Director of Coding and HIM

HCPro, Inc.

Marblehead, MA

� Robert S. Gold, MD

CEO

DCBA, Inc.

Atlanta, GA

2

Agenda and Approach

� The clinical differences between Type I and Type II

diabetes—and all of the other kinds of diabetes

� The rules and assigning of correct codes to the highest

degree of specificity

� Coding and documentation traps coders sometimes fall

into

� Proposed code expansions related to diabetes in

preparation for ICD-10 and involvement of the medical

staff

� Physician documentation pitfalls and best coding needs

� How to engage physicians for more information to

avoid making assumptions based on the documentation

3Diabetes Coding: Understand the disease and its documentation requirements

EXHIBIT A

3

Goals and Objectives

� At the end of the audioconference, you (participants)

will be able to:

� Illustrate the clinical differences between diseases caused by

diabetes versus diseases in diabetics and how to correctly

code them

� Identify the basics of the clinical classification of all forms of

diabetes and the impact on coding

� Explain uncontrolled v. poorly controlled diabetes and the

appropriate coding assignments based on documentation in

the medical record

� Summarize current coding guidelines and what is expected

for 2008

� Understand how to query a physician using information

obtained in the medical record to assign the most specific

diabetic codes

4

Definitions and Determinations

� Diabetes [Mid-16th century. Via Latin < Greek, "passer

through, siphon" < diabainein "go through"]—a disease

whereby the patient produces an excess amount of urine

� Mellitus—sweet, as honey—causes fruity odor to

breath when Type I diabetic is in ketoacidosis (ONLY

Type I patients develop true ketoacidosis!)

� Insipidus—bland—due to posterior pituitary tumor that

produces large amounts of urine through lack of ADH

(antidiuretic hormone) whose job it is to conserve water

(central diabetes insipidus) or lack of reaction by the

kidneys (nephrogenic diabetes insipidus)

EXHIBIT A


5

“Poly” Want a Diagnosis?

� Poly uria—excessive

urination

� Poly dipsia—excessive

thirst

� Poly phagia—excessive

hunger

6

Diabetes

� Juvenile (IDDM) –Type Idiabetes occurs in a state ofinsulin deficiency resultingfrom pancreatic beta celldestruction

� Adult (NIDDM)—Type IIdiabetes results fromincreased resistance to theeffects of insulin. Thesepatients may require insulinfor control.


EXHIBIT A

7

Coding Type I vs. Type II Diabetes

� Category 250.xx

� Fourth digit is based on

accompanying

manifestations/complications

� Fifth Digit is based on the “Type”

of Diabetes and the nature of the

diabetes (not stated as

uncontrolled and uncontrolled)

• Per the official guidelines, “if the

type of diabetes mellitus is not

documented in the medical record

the default is type II.”

8


� Use of acronym “IDDM” and

“NIDDM”

� In 2005, the acronym was removed

from the 5th digit description in the

ICD-9-CM Manual

� A physician must document that the

patient is a Type I diabetic to utilize

a 5th digit of 1 or 3.

• Per the AHA’s Coding Clinic 2Q

2004, the administration of insulin

has no effect on code assignment.

Only the type of diabetes (I or II)

affects code assignment. Assign

fifth digit “0” if the type is

unspecified in the diagnosis and

additional information as to type is

not available.

EXHIBIT A


9


� Use of V58.67 as an additionalcode

� Code V58.67 should beassigned when a patient ismaintained on insulin for TypeII diabetes mellitus.

� Code V58.67 should not beassigned if insulin is giventemporarily to bring a type IIpatient’s blood sugar undercontrol during an encounter.

� It is not necessary to reportV58.67 when a patient has typeI diabetes mellitus since it isimplied that the patient is oninsulin (via pump or injection).

10

Diabetes Terminology

� Is it Type I or Type II?

� Type II on insulin option

� Is it some other etiology?

� Is it controlled or uncontrolled?

� HbA1C

� Is it related to other problems?

� Gastroparesis? Retinopathy? Renal failure? Peripheral

neuropathy? Etc.


EXHIBIT A

11

Etiologic Classification of Diabetes

� Type I diabetes—beta cell destruction, usually leading

to absolute insulin deficiency

� Type II diabetes—insulin resistance or deficiency plus

resistance

12

Coding Uncontrolled vs. Poorly

Controlled Diabetes

� Fifth-digits for Category 250

� 0- Type II, or unspecified type, not stated as uncontrolled

� 1- Type I, not stated as uncontrolled

� 2- Type II, or unspecified type, uncontrolled

� 3- Type I, uncontrolled

• “Poorly controlled” is a non-essential modifier and does not

affect fifth-digit assignment

– Query the physician to determine whether “poorly controlled” and

“poor control” is indicative of uncontrolled blood glucose levels for

this patient.

EXHIBIT A


13

Etiologic Classification of Diabetes

� Other specific types (Secondary causes of Diabetes)

� Genetic defects of beta cell function

� Genetic defects in insulin action

• Type A insulin resistance

• Leprechaunism

• Rabson Mendenhall syndrome

• Lipoatrophic diabetes

14

More Diabetes

� Diseases of the exocrine pancreas

• Pancreatitis

• Trauma/pancreatectomy

• Neoplasia

• Cystic fibrosis

• Hemachromatosis

• Fibrocalculous pancreas

� Endocrinopathies

• Acromegaly

• Cushing’s syndrome

• Glucagonoma

• Hyperthyroidism

• Somatostatinoma

• Aldosteronoma


EXHIBIT A

15

Even More Diabetes

� Drug or chemical induced

• Vacor

• Pentamidine

• Nicotinic acid

• Steroids (glucocorticoids)

• Thyroid hormone

• Beta agonists

• Thiazides

• Dilantin

• Alpha interferon

� Infections

• Congenital rubella

• Cytomegalovirus

� Uncommon immune-mediated diabetes

• “Stiff man” syndrome

• Anti-insulin receptor antibodies

16

Son of Diabetes

� Other genetic syndromes

• Down’s syndrome (758.0)

• Klinefelter’s syndrome (758.7)

• Turner’s syndrome (758.6)

• Wolfram’s syndrome (253.5, 250.xx, 377.10, 389.xx))

– A syndrome comprising diabetes insipidus, a mild form of diabetesmellitus, optic atrophy, and deafness. It is an autosomal recessiveinherited disorder, with the chromosomal abnormality on the shortarm of chromosome. Also called DIDMOAD, for diabetesinsipidus, diabetes mellitus, optic atrophy and deafness

• Friedrich’s ataxia (334.0)

• Huntington’s chorea (333.4)

• Porphyria (277.1)

• Lawrence Moon Biedl syndrome (759.89)

� Myotonic dystrophy (359.2)

� Prader Willi syndrome (759.81)

� Gestational Diabetes

EXHIBIT A


17

Other Diabetes Considerations

� Diabetes insipidus

� Not diabetes mellitus at all

� Related to posterior pituitary malfunction (central) or renalresponse to ADH (nephrogenic)

� Characterized by excess thirst (drinking) and excess urineproduction—same as two of three DM characteristics

� Type 1 � Diabetes

� Recent discussions of a patient with SOME decrease ininsulin production (like Type I) who develops early non-responsiveness to that insulin (like Type II), neither of whichwould have become manifest alone

� Type 3 Diabetes

� Even newer classification—not even confirmed toexist—related to sugar metabolism in the brain

� Not a recognized term by ADA

18

Coding “Other” Diabetes

� Drug or chemical induced (e.g., steroids)

� ICD-9-CM code 251.8, Other specified disorders of

pancreatic internal secretion

• Per the AHA Coding Clinic 2Q 1998, it is inappropriate to use

a code from category 250 for “secondary” diabetes mellitus.

� Gestational diabetes

� ICD-9-CM code 648.8x, Abnormal glucose tolerance

• Use additional code V58.67, if applicable

• Do not report in addition to codes 790.2x or 250.xx

� Diabetes insipidus

� ICD-9-CM code 253.5

� Type 1 � and 3

� Currently, there are no ICD-9-CM codes for these

classifications


EXHIBIT A

19

Anatomy of Pancreas

Duodenum12

Tail of pancreas11

Omental tuber10

Inferior margin9

Anterior margin8

Superior margin7

Inferior surface6

Anterior surface5

Body of pancreas4

Pancreatic notch3

Uncinate process2

Head of pancreas1

http://training.seer.cancer.gov/ss_module13_biliary_tract/unit02_sec01_anatomy.html

20

Periampullary Anatomy

http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm

EXHIBIT A


21

Functional Components of Pancreas

� Exocrine

� Digestive enzymes

� Acinar glands

� Ducts

� Endocrine

� Glands of Islet cells

• Beta cells insulin

• Alpha cells glucagon

• Delta cells somatostatin

� No ducts

http://www.fda.gov/cber/genetherapy/pancislet.htm

Somatostatin inhibits parietal

cells, gastrin stimulates them

Insulin drops blood sugar,

glucagon raises it

22

Problems with Pancreas

� Malfunction

� Tumors

�Exocrine tumors

�Endocrine tumors—gastrinoma, glucagonoma, insulinoma

� Zollinger-Ellison (ZE) Syndrome—gastrinoma

� Inflammation—pancreatitis

�Alcohol

�Gallstone

�Viral

� Trauma

� Posterior penetrating ulcers

� Splenic artery aneurysm


EXHIBIT A

23

Distant Manifestations of Diabetes

� Vascular disease—3 of 4 diabetes deaths from heart andperipheral vascular disease

� Peripheral vessels including carotids

� Heart vessels

� Triopathy—no code for all three—must name them

� Neuropathy

• Autonomic neuropathy—often presents as syncope

• Gastroparesis

• Sensory loss—leads to Charcot Foot and Diabetic footulcers

� Retinopathy—two types

• Proliferative—too many blood vessels trying to heal retina

• Non-proliferative—not enough blood flow due to death ofretina

� Nephropathy—leads to CKD

� Also have dermopathy

24

What Vessels are Involved?� Starts in heart

� Aorta

� Major arteries (brachiocephalic,

carotid, subclavian, renals, mesenterics,

common iliacs)

� Next level major vessels (axillary,

colics, femorals, etc.)

� And so on and so on and so on to

radial, ulnar, dorsalis pedis, etc.

� Finally to precapillaries and capillaries

� Diabetes vascular changes are

microvascular disease

� A bypass is done for atherosclerotic

disease of major blood vessels—it may

help heal diabetic microvascular

problems by increasing inflowhttp://diabetes.niddk.nih.gov/dm/pubs/stroke/

EXHIBIT A


25

Risk of Atherosclerosis Increased

� Diabetic patients develop

atherosclerosis more

rapidly than non-diabetics

� Major vessel occlusion is

still atherosclerosis in a

diabetic

� Risk of heart attack, stroke

doubled in diabetics

� Risk of second event

higher than non-diabetics

and higher potential for

mortalityhttp://www.nhlbi.nih.gov/health/dci/Diseases/Athero

sclerosis/Atherosclerosis_WhatIs.html

26

What Bypasses Do You See?

�Aorto-iliac

�Aorto-bifemoral

�Aorto-femoral, fem-fem

�Femoropopliteal bypass

�Femoro-anterior tibial bypass

�Aorto-mesenteric

�Aorto-renal

All for atherosclerotic occlusive disease. Patient may havenon-healing diabetic foot ulcer, but is non-healing becauseof inoperable microvascular disease or inadequate inflow.

Options: Angioplasty and stent, endarterectomy—youdon’t remove sugar!


EXHIBIT A

27

Diabetic Foot Ulcer? Query!

� There are three primary types of ulcerations of the lower extremity

that will require referral to the Vascular Surgery Service.

� Type 1: Ulceration of the distal extremity, typically the toes, due to

arterial insufficiency. These can be painful and despite good local

wound care fail to heal due to a lack of adequate blood supply.

Treatment involves careful wound management and improvement of

blood flow to the extremity, which often requires operative

intervention.

� Type 2: Ulceration due to a neurotrophic ulcer in diabetics. This

type is typically over bony prominences and is generally painless

unless it is also infected. Treatment includes alleviation of any

weight-bearing on this pressure area, controlling infection and

assuring adequate blood flow.

� Type 3: Ulceration in the lower extremities is due to venous

insufficiency. Management goals are proper support of the lower

extremities with some type of compression dressing as well as

controlling infection.

http://www.mamc.amedd.army.mil/referral/guidelines/derm_extremityulcer.htm

28

Retinopathy

� Complication of diabeticmicrovascular changes

� Leads to ischemia ofretina

� Ischemia can lead tocompensatoryproliferation of bloodvessels or death of tissue

� Nonproliferativeretinopathy

� Proliferativeretinopathy—this iswhat laser treatment isfor—to cauterizeproliferating vessels thatblock light from hittingretina

http://nihseniorhealth.gov/diabeticretinopathy/

whatisdiabeticretinopathy/eye_popup.html

EXHIBIT A


29

Nephropathy

� Decrease in GFR over time,

progression to ESRD

� May be called Kimmelstein-

Wilson Disease or diabetic

glomerulosclerosis

� Thickening of glomerulus—protein

loss—microalbuminuria

� Loss of glomeruli through microvascular ischemic

change

� Progression until gross albuminuria and hypertension

which results FROM THE DIABETIC VASCULAR

CHANGES

http://bicmra.usuhs.mil

30

Coding Diabetic Manifestations

� Fourth-digits for Category 250.xx

� Identify the absence or presence of

complications/manifestations

• 250.1x-250.3x- Complications

– E.g., Ketoacidosis

• 250.4x-250.8x- Manifestations

– Renal (e.g., nephropathy)

– Ophthalmic (e.g., retinopathy)

– Neurological (e.g., gastroparesis)

– Peripheral circulatory disorders (e.g., gangrene)

– Other (e.g., ulcerations)

» Use additional code to identify the specific manifestations


EXHIBIT A

31

Coding Diabetic Manifestations

� Are these conditions inherently assumed to be

diabetic related if listed with a diagnosis of

diabetes mellitus?

�NO!!!

• Per the AHA Coding Clinic, 1Q, 2004, Conditionslisted with a diagnosis of diabetes mellitus or in adiabetic patient are not necessarily complications ofthe diabetes. The condition should be coded as suchonly when the physician identifies it as a diabeticcomplication.

32

Functional Anatomy of Kidney

http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/yourkidneys.pdf

Erythropoietin is

produced by

peritubular

capillary

endothelium

EXHIBIT A


33

Proposed Additional Codes for 2008

� New category 249 Diabetes mellitus due to underlyingcondition� Diabetes due to adverse effect of drug

� Diabetes mellitus due to late effect of adverse effect of drug,disease, and poisoning

� Secondary diabetes mellitus

� Code first underlying condition, such as:� Cushing’s syndrome (255.0)

� Cystic fibrosis (277.00-277.09)

� Malignant neoplasm of pancreas (157.0-157.9)

� Poisoning—see table of drugs and chemicals

� Use additional code to identify:� Adverse effect of drug—see table of drugs and chemicals

� Any associated insulin use (V58.67)

� Late effect of adverse effect of drug, poisoning and trauma909.5, 909.0, 908.1)

� Personal history of pancreatitis (V12.79)

34

Proposed Additional Codes

� New code 249.0 Diabetes mellitus due to underlying

condition without mention of complication


condition with ketoacidosis


condition with hyperosmolarity


condition with other coma


condition with renal manifestations


condition with ophthalmic manifestations


EXHIBIT A

35


condition with neurological manifestations


condition with peripheral circulatory disorders


condition with other specified manifestations


condition with unspecified complication

Proposed Additional Codes

Exhibit B

Link to the report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitusand a table of Etiologic Classifications of Diabetes Mellitus

Source: Robert S. Gold, MD


EXHIBIT B

LINK to Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus

http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s5

��

TABLE 1Etiologic Classifications of Diabetes Mellitus

Type 1 diabetes mellitus*

Type 2 diabetes mellitus*

Other specific types:

Genetic defects of beta-cell functionGenetic defects in insulin actionDiseases of the exocrine pancreas

PancreatitisTrauma/pancreatectomyNeoplasiaCystic fibrosisHemochromatosisOthers

EndocrinopathiesAcromegalyCushing's syndromeGlucagonomaPheochromocytomaHyperthyroidismSomatostatinomaAldosteronomaOthers

Drug- or chemical-inducedVacor†PentamidineNicotinic acidGlucocorticoidsThyroid hormoneDiazoxideBeta-adrenergic agonistsThiazidesPhenytoinAlfa-interferonOthers

InfectionsCongenital rubellaCytomegalovirusOthers

Uncommon forms of immune- mediated diabetesOther genetic syndromes sometimes associatedwith diabetes

Down syndromeKlinefelter's syndromeTurner's syndromeWolfram syndromeFriedreich's ataxiaHuntington's choreaLawrence-Moon Beidel syndromeMyotonic dystrophyPorphyriaPrader-Willi syndromeOthers

Gestational diabetes mellitus

*--Patients with any form of diabetes may require insulin treatment at some stage of the disease. Use of

insulin does not, of itself, classify the patient.

†--Vacor is an acute rodenticide that was released in 1975 but withdrawn as a general-use pesticide in 1979

because of severe toxicity. Exposure produces destruction of the beta cells of the pancreas, causing diabetes

mellitus in survivors.

Exhibit C

Quizlet: ICD-9 Coding for Diabetes Mellitus

Source: HCPro, Inc.


EXHIBIT C


1. A patient who is 10 years old is diagnosed with diabetes mellitus. The physician

does not specify whether the patient is a Type I or Type II diabetic. The patient

has no associated manifestations or complications. What is the correct code?

a. 250.01

b. 250.00

c. 790.29

d. 250.02

2. A patient with Type II diabetes that is normally controlled on Glucophage is

temporarily placed on sliding scale insulin to stabilize his glucose levels. The

patient has no associated manifestations or complications. What is the correct

code(s)?

a. 250.00, V58.67

b. 250.01

c. 250.01, V58.67

d. 250.00

3. A patient presents to an ophthalmologist’s office for treatment of diabetic

cataracts. The patient is a Type I diabetic. What is the correct code(s)?

a. 366.9, 250.01

b. 250.51, 366.41

c. 366.41, 250.51

d. 250.01, 366.41

4. A patient presents to an emergency room in a diabetic hypoglycemic coma (not

hyperosmolar) due to the failure of her insulin pump. The patient is a Type I

diabetic. What are the appropriate code(s)?

a. 996.57, 962.3, 250.31, E932.3

b. 996.57, 962.3, 250.33, E932.3

c. 996.57, 250.31, E932.3

d. 251.0, 250.01, 996.57, 962.3, E933.3

5. A patient is documented as having diabetes mellitus in a medical record. Patient

medication administration record states he is are on Humulin 70/30. There is no

further documentation to specify the type of diabetes. What is the appropriate

code(s)?

a. 250.00

b. 250.01

c. 250.00, V58.67

d. 250.01, V58.67

EXHIBIT C



ANSWERS

1. = b. 250.00

2. = d. 250.00

3. = b. 250.51, 366.41

4. = c. 996.57, 250.31, E932.3

5. = a. 250.00

Exhibit D

List of HIM “Acronyms to Know”

Source: HCPro, Inc.

EXHIBIT D

26 Diabetes Coding: Understand the disease and its documentation requirements- 1 -

HIM Acronyms to Know

AAPC American Academy of Professional Coders

AHA American Hospital Association

AHIC American Health Information Community

AHIMA American Health Information Management Association

AHRQ Agency for Health Care Research and Quality

AMI Acute myocardial infarction

AOA American Osteopathic Association

APCs Ambulatory payment classifications

APR DRG All Patient Refined Diagnosis Related Group System

ASC Ambulatory surgical center

ASP Average sales price

AWP Average wholesale price

BBA Balanced Budget Act of 1997, Pub. L. 105-33BLS Bureau of Labor Statistics

CAH Critical access hospital

CART CMS Abstraction & Reporting Tool

CBSAs Core-based statistical areas

CC Complication or comorbidity

CCHIT Certification Commission for Health Information Technology

CCR Continuity of care record/Cost to charge ratio

CDAC Clinical Data Abstraction Center

CDM Charge description master

CPI Consumer price index

CMI Case-mix index

CMS Centers for Medicare & Medicaid Services

CMSA Consolidated Metropolitan Statistical Area

COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99-272

CPI Consumer price index

CPT Current Procedural Terminology

CRNA Certified registered nurse anesthetist

CT Computed tomography

CY Calendar year

DED Dedicated emergency department

DRA Deficit Reduction Act of 2005, Pub. L. 109-171

DRG Diagnosis-related group

DSH Disproportionate share hospital

ECI Employment cost index

ED Emergency department

EHR Electronic health record

EMR Electronic medical record


EXHIBIT D

- 2 -

EMTALA Emergency Medical Treatment and Labor Act of 1986, Pub. L. 99-272

EOB Explanation of benefits

FDA Food and Drug Administration

FFY Federal fiscal year

FI Fiscal intermediary

FQHC Federally qualified health center

FY Fiscal year

GAAP Generally Accepted Accounting Principles

GAF Geographic Adjustment Factor

GME Graduate medical education

HCFA Health Care Financing Administration

HCPCS Healthcare Common Procedure Coding System

HCRIS Hospital Cost Report Information System

HHA Home health agency

HHS Department of Health and Human Services

HIC Health insurance card

HIMSS Health Information Management Systems Society

HIPAA Health Insurance Portability and Accountability Act of 1996

HIS Health information system/services

HIT Health information technology

HMO Health maintenance organization

HSA Health savings account

HSRVcc Hospital-specific relative value cost center

HQA Hospital Quality Alliance

HQI Hospital Quality Initiative

HwH Hospital-within-a-hospital

ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification

ICD-10-PCS International Classification of Diseases, Tenth Edition Procedure Coding System

ICU Intensive care unit

IHS Indian Health Service

IME Indirect medical education

IOM Institute of Medicine

IPF Inpatient psychiatric facility

IPPS Acute care hospital inpatient prospective payment system

IRF Inpatient rehabilitation facility

IT Information technology

JCAHO Joint Commission on Accreditation of Healthcare Organizations

LCD Local coverage determination

LTC-DRG Long-term care diagnosis-related group

LTCH Long-term care hospital

EXHIBIT D

28 Diabetes Coding: Understand the disease and its documentation requirements- 3 -

MAC Medicare administrative contractor

MCE Medicare Code Editor

MCO Managed care organization

MCV Major cardiovascular condition

MDC Major diagnostic category

MDH Medicare-dependent, small rural hospital

MedPAC Medicare Payment Advisory Commission

MedPAR Medicare Provider Analysis and Review File

MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L.

108-173

MRHFP Medicare Rural Hospital Flexibility Program

NAHIT National Alliance for Health Information Technology

NCCI National Correct Coding Initiative

NCD National coverage determination

NCHS National Center for Health Statistics

NCQA National Committee for Quality Assurance

NCVHS National Committee on Vital and Health Statistics

NHIN National health information network

NICU Neonatal intensive care unit

NPI National provider identifier

NQF National Quality Forum

NVHRI National Voluntary Hospital Reporting Initiative

OCE Outpatient code editor

OCR Office for Civil Rights

OES Occupational employment statistics

OIG Office of the Inspector General

OMB Executive Office of Management and Budget

OPPS Outpatient prospective payment system

OR Operating room

OSCAR Online Survey Certification and Reporting (System)

PPI Producer price index

PPS Prospective payment system

PRA Per resident amount

ProPAC Prospective Payment Assessment Commission

PRM Provider Reimbursement Manual

PRRB Provider Reimbursement Review Board

PS&R Provider Statistical and Reimbursement (System)

QIG Quality Improvement Group, CMS

QIO Quality Improvement Organization


EXHIBIT D

- 4 -

RA Remittance advice

RC Revenue code

RHC Rural health clinic

RHIO Regional health information organization

RHQDAPU Reporting hospital quality data for annual payment update

RRC Rural referral center

RY Rate year

SAF Standard Analytic File

SCH Sole community hospital

SNF Skilled nursing facility

SOCs Standard occupational classifications

SSA Social Security Administration

SSI Supplemental Security Income

ST Status indicator

TAG Technical Advisory Group

TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248

UHDDS Uniform hospital discharge data set

Resources

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RESOURCES

32 Diabetes Coding: Understand the Disease and Its Documentation Requirements

HCPro sites

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33Diabetes Coding: Understand the Disease and Its Documentation Requirements

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