Tuesday, November 19, 2019

Diabetes 1.5

This edition of “In the kNOW”  shares information on proper coding for diabetes 1.5.  Most coding professionals are familiar with type 1 and type 2 diabetes.  Type 1 diabetes occurs when the pancreas does not produce insulin at all or very little.  This prevents cells from absorbing glucose necessary to produce energy and requires insulin administration for treatment.  Type 2 diabetes on the other hand can be due to either insulin resistance or insufficient insulin production with treatment either oral hypoglycemic medications or insulin.  
Diabetes 1.5 is also known as latent autoimmune diabetes in adults or LADA.  Where type 1 diabetes usually is diagnosed in childhood, type 1.5 diabetes is most often being identified in patients over 30.  Progression of the disease is slow, with initial management being similar to that for type 2: weight reduction, exercise, proper diet, and possibly oral medications.  As the disease progresses, which could be months to years, it will become necessary to switch to insulin as the main treatment.

Patients should be aware of the three P’s of diabetes.  These symptoms can often indicate that the patient is a diabetic: polyphagia (excess hunger), polyuria (excess urination), and polydipsia (excess thirst). 

Coding professionals know that type 1 diabetic conditions will fall into the E10 category: Type 1 diabetes.  Type 2 diabetes is found in category E11.  Type 1.5 diabetes will be category E13; Other specified diabetes.

A recent Coding Clinic from 2018, the third quarter, shares that if a physician indicates a patient has both type 1 and type 2 diabetes, that correlates to type 1.5 with category E13 being the appropriate category for coding that type of diabetes.

Coding professionals are reminded to use combination codes for diabetes “with” conditions.  Using type 2 diabetes in the following examples it would include conditions such as neuropathy (E11.40), hyperglycemia (E11.65), chronic kidney disease (E11.22), etc.  

It should also be mentioned, when the type of diabetes is not specified by the provider in the record, the default is type 2.  

Capturing the long-term use of insulin (Z79.4) or oral hypoglycemic medications (Z79.84) is also important when coding for diabetes.  While the classification does not require the use of the Z79.4 for insulin usage in type 1 diabetic patients, other types of diabetes have an instructional note reminding coders to add the long-term use of medication code as appropriate.  The long-term use of insulin may be coded for type 1 diabetics if a facility chooses.  A reminder that when insulin is used temporarily for a short-term control of type 2 diabetes, it should not be coded. 
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.