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January 3, 2020

Diabetes, Coding, and Telehealth

As a provider, you can use a variety of tools - such as telehealth - to help patients manage their diabetes. To ensure accurate billing and recordkeeping, you should verify that diabetes and its related conditions are coded properly during encounters.


Using Telehealth for Diabetes Management

After an individual is diagnosed with diabetes, the next question that often arises is how to help them manage their health. One potential tool for this job is telehealth. In particular, telehealth and telemedicine can be one way to help groups that often struggle with diabetes, such as veterans and rural populations.


Veterans


There have been many clinical trials conducted to see if telehealth is an effective tool for helping veterans manage their diabetes. The answer is often “yes.” For example, last year, a review was con​ducted of patients with type 1 diabetes who were enrolled in the Atlanta VA Medical Center Endocrinology Telehealth Clinic from June 2014 to October 2016. Ultimately, this study found that telemedicine led to higher patient satisfaction, savings of both time and costs, and higher appointment adherence rates.


Another example of telehealth being used to support veterans’ diabetes management is a 2015 pilot study examining the effectiveness of a telehealth program at the Durham VA Medical Center. In this initial study, the researchers acknowledged that intensive telehealth does not fit everyone’s preferences for health care. However, many of the patients who chose to participate in this study found that the telehealth program fit their lifestyle well.


Participants in the Durham VA Medical Center telehealth program had slightly improved average blood sugar in comparison to participants who received usual care. Though this was a relatively small difference, the researchers argued that over time this improvement could significantly decrease the risk of complications such as heart attacks. Telehealth program participants also had lower blood pressure after six months in comparison to the usual-care group, another difference that could potentially lead to better overall health results.


Rural Populations


According to the CDC, people who live in rural areas have higher rates of diabetes than their urban counterparts, which in turn can increase the likelihood that they will develop heart disease or have a stroke. However, despite higher rates of diabetes and other equally serious health conditions, rural populations also have lower rates of participation in diabetes self-management education and support (DSMES) programs.


One potential solution that has been suggested to address these needs of individuals in rural areas is to provide alternative locations for delivery of DSMES programs. For example, in addition to providing more accessible in-person locations such as pharmacies and community centers, digital locations using telehealth are also recommended.


If your organization uses telehealth to help patients manage their diabetes, make sure that you are meeting all of the requirements for telehealth services. Remember that there are requirements for originating sites, distant site practitioners, and the telecommunications system used to provide real-time communication between the practitioner and Medicare beneficiary. Medicare has a number of resources, such as Medicare Learning Network articles, that providers can use to review telehealth billing requirements. You might also consider using healthcare compliance training to review some of the compliance regulations that might apply to telehealth services.


Coding Diabetes

In previous blog articles, we have discussed some of the coding guidelines for diabetes. ICD-10 uses combination coding for diabetes that includes the type of diabetes, the body system affected, and any complications. You should assign as many codes from categories E08-E13 as are needed to identify all of the associated conditions that a patient has.


E08.00-E08.9

Diabetes mellitus due to underlying condition

E09.00-E09.9

Drug or chemical induced diabetes mellitus

E10.10-E10.9

Type 1 diabetes mellitus

E11.00-E11.9

Type 2 diabetes mellitus

E13.00-E13.9

Other specified diabetes mellitus


The best way to determine which diabetes category is the most appropriate for an individual is to review the medical documentation. When the type of diabetes is not documented in a patient’s medical record, the default code is E11.-, type 2 diabetes. Similarly, when the medical record documentation does not indicate the type of diabetes a patient has, but does indicate that the patient uses insulin, use code E11.- for type 2 diabetes.


Please note the following guidelines for E11.-:

  • Includes:
    o  Diabetes (mellitus) due to insulin secretory defect
    o  Diabetes NOS (not otherwise specified)
    o  Insulin resistant diabetes (mellitus)
  • Use additional code to identify control using:
    o  Insulin (Z79.4)
    o  Oral antidiabetic drugs (Z79.84)
    o  Oral hypoglycemic drugs (Z79.84)
  • Excludes1:
    o  Diabetes mellitus due to underlying condition (E08.-)
    o  Drug or chemical induced diabetes mellitus (E09.-)
    o  Gestational diabetes (O24.4-)
    o  Neonatal diabetes mellitus (P70.2)
    o  Postpancreatectomy diabetes mellitus (E13.-)
    o  Postprocedural diabetes mellitus (E13.-)
    o  Secondary diabetes mellitus NEC (E13.-)
    o  Type 1 diabetes mellitus (E10.-)

If a pregnant woman is diabetic, they should first be assigned a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium before assigning the appropriate diabetes code(s) from E08-E13.

O24.011‑O24.03

Pre-existing type 1 diabetes mellitus, in pregnancy, childbirth and the puerperium

O24.111‑O24.13

Pre-existing type 2 diabetes mellitus, in pregnancy, childbirth and the puerperium

O24.311‑O24.33

Unspecified pre-existing diabetes mellitus in pregnancy, childbirth and the puerperium

O24.410‑O24.439

Gestational diabetes mellitus

O24.811-O24.83

Other pre-existing diabetes mellitus in pregnancy, childbirth, and the puerperium

O24.911‑O24.93

Other pre-existing diabetes mellitus in pregnancy, childbirth, and the puerperium


One important guideline to remember for category O24 codes is that no other code from category O24 should be used with a code from O24.4.


Conclusion

We will continue looking at this serious health condition and how it is linked to heart disease, kidney damage, diabetic retinopathy and other complications in future articles. Stay tuned here on the AIHC Blog or subscribe to receive a notification when we publish new articles. Also, for a more extensive look at coding diabetes, watch for our new course Key to ICD-10-CM Compliance – Coding Diabetes coming in early 2020!

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