New Changes to the Official Coding and Reporting Guidelines for Diabetic Medications

November is Diabetes Awareness Month.

November is Diabetes Awareness Month, and it seems additionally appropriate to review diabetes when there is a focus on chronic diseases.    

According to the World Health Organization (WHO), diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. The incidence of diabetes has increased from 108 million cases recorded in 1980 to 422 million in 2014. Diabetes also increases premature mortality. A healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco are all habits meant to prevent or delay the onset of Type 2 diabetes.

There was a Coding Clinic edition published in the first quarter of 2020 that cited a patient with a history of type 2 diabetic neuropathy and bariatric surgery. The physician documented that the patient’s diabetes had resolved after the bariatric surgery. The same patient presented with an ulceration of the right foot with acute osteomyelitis due to diabetic polyneuropathy.  

The question was if the osteomyelitis and polyneuropathy could be coded as diabetic complications. The Coding Clinic response is to assign E11.42 (diabetes mellitus, type 2 with polyneuropathy), E11.69 (diabetes mellitus, type 2 with other complication), M86.171 (other acute osteomyelitis), and L97.511 (non-pressure chronic ulcer of other part of the right foot limited to breakdown of the skin). Z98.84 may also be assigned for the bariatric surgery status. The commentary added that even though the glucose levels had normalized, the patient still has diabetic complications.

There have been changes to the Official Coding and Reporting Guidelines for the 2021 fiscal year regarding diabetic medications of which you should be aware. These changes include:

  • If the patient is treated with oral hypoglycemic medication and insulin, only assign the Z79.4 for long-term use of insulin, which is not a change for 2021.
  • If the patient is treated with both insulin and injectable non-insulin anti-diabetic drug, assign Z79.4 and Z79.899 (other long-term drug therapy).
  • If the patient is treated with both oral hypoglycemic medications and injectable non-insulin anti-diabetic drug, assign Z79.84 (long-term use of oral hypoglycemic drugs) and Z79.899. In 2020, the Official Coding and Reporting Guidelines indicated that if the patient was treated with insulin and oral hypoglycemic drugs, assign only Z79.84.

Code Z79.4 is a Hierarchical Condition Category (HCC), so when working with Medicare Advantage payers or payers utilizing HCCs for reimbursement, this code is important to report. The diabetic codes are also HCCs. The specificity of the diabetic code affects the HCC assignment.  

Remember to take time to check your A1C in the month of November.

Programming Note: Laurie Johnson is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays. Listen to her live reporting on ICD-10 codes every Tuesday at 10 a.m. EST.

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