Even people who know only the basics of risk adjusted payments know that there is a hierarchy in coding diabetes. Diabetes with no complications contributes about two-thirds less in funding when compared to diabetes with a complication. The unfortunate reality of diabetes mellitus (DM) is that sooner or later, patients often develop a complication.
In the world of ICD-10 coding, though, the manifestation doesn’t necessarily need to have been caused by DM. There are conditions that are coded as diabetic manifestations when they occur with DM, not due to, or secondary to, it. In fact, the ICD-10-CM book lists the conditions that are supposed to be coded as diabetic manifestations. These reflect coding rules and even if the conditions are not linked by the provider, proper coding requires coders to change ICD-10-CM codes prior to transmission of the claim or encounter.
The most common diabetic manifestations are: chronic kidney disease, peripheral vascular disease, polyneuropathy and cataracts. That’s right. Cataracts. Sometimes coding rules defy logic to a certain degree but we’re bound by them. As you can see on this graphic by the National Institutes of Health, the prevalence of cataracts increases with age. In fact, the graphic defines a cataract as “a clouding of the lens in the eye that affects vision” and goes on to explain that, “Most cataracts are related to aging. Cataracts are very common in older people.” In risk adjustment, the cataract would be linked to DM, coding-wise, regardless of its prevalence in all adults, diabetic or not.
In our MRA work, however, we see some unique pairings, such as habitually linking hyperlipidemia to DM. This is one manifestation that should be rare but we routinely encounter practices for which this is the #1 complication among diabetic patients. To be sure, this link must be made by the clinician, and not the coder. It shouldn’t even be suggested by the coder, in our opinion. Atherosclerosis is another one gaining popularity among some practices. Coders will routinely link DM to atherosclerosis of the aorta, another commonly occurring condition. This is not a recognized diabetic complication.
We understand the incentive to report at least one diabetic manifestation because of its effect on payments, but we must be careful to stay within the realm of medical and coding reality. Request a FREE copy of the ICD-10-CM automatic diabetic manifestations and run a report of what’s being coded in your practice. And join us in the next installment of this blog series where we’ll go through the most common diabetic complications in a little more detail.