Training Data Entry II Training Course: Supervisor

PCC Supervisor/Manager PCC Operation Guidelines

Rating for one Operator Annual Production Rating Formula Fair 20,000 visits 85 forms per day x 230 days per year Good 40,000 visits 170 forms per day x 230 days per year Outstanding 60,000 visits 260 forms per day x 230 days per year

2 PCC Data Entry Needs and Qualifications • On-Reference Material including: • English & Medical Dictionaries • Medical Abbreviations Book • Up-to-date ICD Coding Books • Drug Handbook-Nursing • Data Entry of 20,000 Forms per year by Trained Individual (about 80 forms per day using six to eight mnemonics). • Number of forms processed or data items entered dependent upon each Area or Site.

3 PCC Data Entry Needs and Qualifications (cont.) • Data Entry Staff with the following skills: • Computer keyboard skills • Ability to read provider’s handwriting • Knowledge and understanding of Medical Terminology • Knowledge and understanding of ICD Coding • Knowledge and understanding of Anatomy and Physiology

4 The International Classification of Diseases • ICD-9-CM: 9th Revision, Clinical Modification • The RPMS Coding System for Diagnoses and Procedures

5 ICD Lookup Process

• Enter Provider Narrative • FQ Used File • Synonym File • Key Word File • Possible Code(s)

6 Diabetes Diagnosis Codes 250.00 - 250.93 • Type 1 Diabetes - Insulin Dependent Diabetes (Fairly Rare) • Use the Following fifth digit: • 1 - Indicates controlled • 3 - Indicates uncontrolled Note: Requires insulin to survive

7 Diabetes Diagnosis Codes 250.00 - 250.93 (cont.) • Type 2 Diabetes - Non-Insulin Dependent Diabetes (Most frequent Type) • Use the Following fifth-digit: • 0 - Indicates controlled • 2- Indicates uncontrolled Note: Not dependent on insulin to survive; can produce sufficient amounts but may receive insulin to assist the body in using the insulin present in the body.

8 Assigning the Correct Code

When the provider narrative is: The correct code is: DM Type 2 250.00 DM Type 1 250.01 DM Type 2, uncontrolled 250.02

9 Other Diabetes-related Diagnosis Codes • Two metabolic stages - ICD 2004: • 790.21 - Impaired Fasting Glucose (IFG) • 790.22 - Impaired Glucose Tolerance Test (IGT)

10 790.21 - Impaired Fasting Glucose

• Elevated fasting glucose • What is IFG? • Fasting Glucose 100 – 126 mg/dL Note: Patients are at greater risk for developing Diabetes and associated cardiovascular disease.

11 790.22 - Impaired Glucose Tolerance Test • Elevated glucose tolerance test • What is IGT? • Two Hour Glucose Value 140 to 200 mg/dL after a 75 gram glucose load. Note: Abnormal results generally indicate Diabetes Mellitus or Gestational Diabetes.

12 Other Diabetes-related Diagnosis Codes (cont.) • 790.29 - Other Abnormal Glucose: • Abnormal Glucose NOS • Abnormal non-fasting glucose • Pre-diabetes NOS • 277.7 Dysmetabolic Syndrome (Syndrome X): • Three of five – elevated BP, elevated fasting glucose, elevated LDL, excess waist measurements, low HDL

13 Other Diabetes-related Diagnosis Codes (cont.) • V77.1 - Diabetes/Diabetic/DM Screening • 250.0x - Diabetic Foot Care • Callus - 700. • Mycotic Nails 117.9 • Ingrown Nails 703.0 • Nail Trim 86.27 (ICD procedure use OP/SHX) • 11719 (CPT code)

14 Other Diabetes-related Diagnosis Codes (cont.)

V49.6x - V49.77 - Amputation Status (Acquired) • V49.60 Upper limb, • V49.70 Lower limb, unspecified level unspecified level • V49. 61 Thumb • V49.71 Great toe • V49.62 Other finger(s) • V49.72 Other toe(s) • V49.63 Hand • V49.73 Foot • V49.64 Wrist • V49.74 Ankle • V49.65 Below elbow • V49.75 Below knee • V49.66 Above elbow • V49.76 Above knee • V49.67 Shoulder • V49.77 Hip

15 Diabetes During Pregnancy

• 648.83 - Gestational Diabetes • Individuals who have NOT had DM diagnosed prior to their pregnancy. • A condition that refers to abnormal glucose tolerance during pregnancy. • May require treatment for control of blood glucose levels, but returns to normal glucose tolerance after childbirth.

16 Diabetes During Pregnancy (cont.)

• 648.03 - Pre-gestational Diabetes • Diabetes Complicating Pregnancy. • Individuals who are pregnant but HAD Diabetes prior to their pregnancy. • A secondary code in the 250.0x is always assigned when this code is used.

17 Complications Associated with Diabetes • Complications/Manifestations require two codes including a code from the 250.4x - 250.8x series with an additional code: • “Diabetic” Peripheral Vascular Disease 250.7x plus 443.81* • Foot Ulcer 707.15 • Gangrene 785.4 • Decreased Sensation in Feet 782.0 • Painful Paresthesias 782.0 • Decreased Peripheral Pulses 782.0 • Impotence of Organic Origin 607.84 18

Complications Associated with Diabetes (cont.) • Diabetic Foot Ulcer 250.8x plus 707.15 • Diabetic Nephropathy 250.4x plus 583.81* • Mild Proteinuria 791.0 • Nephrotic Syndrome 581.81 • Chronic Renal Failure 585.9 • ESRD 585.6 Codes marked with an asterisk (*) are manifestation codes. • May never be used alone or indicated as the principal diagnosis. • Must always be preceded by another code.

19 Coding Example 1

Chronic renal failure due to Type 1 diabetic nephrotic syndrome. • Solution: 250.41 (diabetes with renal manifestation) plus: • 585.9 (chronic renal failure) • 583.81 (nephrotic syndrome)

20 Coding Example 2

Ulcer of right foot due to diabetic peripheral vascular disease. • Solution: 250.70 (diabetes with PVD) plus: • 707.15 (foot ulcer) • 483.81 (peripheral vascular disease)

21 Coding Example 3

Bilateral diabetic foot ulcer. • Solution: 250.80 (diabetes) plus: • 707.15 (foot ulcer)

22 Coding Example 4

Pre-gestational diabetes, patient is IDDM, controlled. • Solution: 648.03 (pre-gestational diabetes) plus: • 250.01 (IDDM, controlled) • Common recording problem: OM (otitis media) versus DM Assign correct ICD code when diagnosis is preceded by one of the following terms: R/O; Suspect; Possible; Probable; Questionable, etc. 23 New Diabetes Diagnosis Codes

• 249.0x – 249.9x • Effective 10/1/2008 • Secondary Diabetes Mellitus • Requires 5th digit • 0 not stated as uncontrolled, or unspecified • 1 uncontrolled

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