Coding Clinic Clarifies Diabetes and Complications, Ketoacidosis, and Anti-MAG Polyneuropathy

Apparently the Q1 2016 "clarification" of diabetes with associated conditions confused many people.  In Q2, 2016, Coding Clinic furthers their clarification by stating:

"The subterm "with" in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word "with." The physician documentation does not need to provide a link ..... These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.... For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related."

Coders will have to look to the Index and/or the code description for the term "with" in order to make the determination whether or not the physician must specifically link the diabetes to the complication.


Coding Clinic also addressed Ketoacidosis in Diabetes.  They noted that physicians should be queried if they do not specify the type (i.e. Type 1 or Type 2) of diabetes.  In most cases, when a physician does not state the type of diabetes, the default is Type 2, due to coding rules.  However, ketoacidosis occurs most frequently in Type 1 diabetes. Therefore, when the physician fails to state what type of diabetes the patient has, the physician is to be queried.   This presents problems when coders are reviewing a chart note that is months old, since addenda or late entries should generally be made within a 'reasonable' time frame.  It's especially important to inform physicians that they must state the type of diabetes when documenting ketoacidosis, to avoid coding problems later.

Finally, Coding Clinic was asked what the correct code assignment for Anti-MAG (anti-myelin-associated glycoprotein) polyneuropathy is.   Coding Clinic instructed that code G62.89, Other specified polyneuropathies, should be used.

Most of the other Coding Clinic entries for Q2 were related to procedural coding.

Given the ongoing confusion about diabetic complications, I think that we can expect more Coding Clinic comments on diabetes in the future.

Although Coding Clinic has provided a lot of instruction about the documentation requirements for diabetic complications, physicians don't usually access the Index when documenting in a medical record.  Short descriptions in EMRs don't always provide enough information for physicians to know whether or not linkage exists in the description or index.  Given these limitations, it cannot hurt for physicians to include the causal relationship in their documentation when present.