Endocrine, Nutritional and Metabolic Diseases (E00-E89) Presented by Lawrence Santi, DPM, FASPS November 20, 2014 1 APMA Resources ICD-10 Webinars • Register for upcoming webinars • View archived recordings • Download PDF versions of each presentation • www.apma.org/icd10 APMA’s Coding Resource Center • The single best podiatric online coding resource • www.apmacodingrc.org Questions? Contact APMA’s Health Policy & Practice Department [email protected] 2 ICD-10-CM Resources www.apma.org/icd10 3 APMA Coding Resource Center www.apmacodingrc.org 4 GUIDELINES AND INSTRUCTIONS FOR CHAPTER 4 (E00-E89) 5 Endocrine, Nutritional & Metabolic Diseases (E00-E89) • Excludes1: Transitory endocrine and metabolic disorders specific to newborn (P70-P74). These codes cannot be reported together with other codes in this chapter since the two conditions cannot occur together. 6 Endocrine, Nutritional & Metabolic Diseases (E00-E89) This chapter contains the following blocks: • E00-E07 Disorders of thyroid gland • E08-E13 Diabetes mellitus • E15-E16 Other disorders of glucose regulation and pancreatic internal secretion • E20-E35 Disorders of other endocrine glands • E36 Intraoperative complications of endocrine system 7 Endocrine, Nutritional & Metabolic Diseases (E00-E89) • E40-E46 Malnutrition • E50-E64 Other nutritional deficiencies • E65-E68 Overweight, obesity and other hyperalimentation • E70-E88 Metabolic disorders • E89 Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified 8 E10 Type 1 Diabetes Mellitus Includes: • brittle diabetes (mellitus) • diabetes (mellitus) due to autoimmune process • diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction • idiopathic diabetes (mellitus) • juvenile onset diabetes (mellitus) • ketosis-prone diabetes (mellitus) 9 E10 Type 1 Diabetes Mellitus Excludes 1: This means the following codes cannot be reported together with other codes in this chapter since the two conditions cannot occur together. • diabetes mellitus due to underlying condition (E08.-) • drug or chemical induced diabetes mellitus (E09.-) • gestational diabetes (O24.4-) • hyperglycemia NOS (R73.9) • neonatal diabetes mellitus (P70.2) 10 E10 Type 1 Diabetes Mellitus Excludes 1: • postpancreatectomy diabetes mellitus (E13.-) • postprocedural diabetes mellitus (E13.-) • secondary diabetes mellitus NEC (E13.-) • type 2 diabetes mellitus (E11.-) 11 Diabetic with a Charcot Foot 12 Diabetic Patient With Charcot Changes In this presentation, we will learn to code using the new ICD – 10 classification a patient who presents with: 1. Diabetes Type I 2. Diabetic Polyneuropathy 3. Charcot Changes 4. Anemia 5. Abnormally high glucose 13 Type I Diabetic with Charcot Foot (INITIAL EXAM) Consultation: Referring physician: Dr. XXXXXX Chief complaint: Mrs. Smith is a 52 year old female who presents for an initial exam with numbness of both feet and a “fallen arch” on the right foot. 14 Type I Diabetic with Charcot Foot History of present illness: She states that she noticed the change over the last month. The numbness of both feet was present for about 2 years. She is now seeking help because she has difficulty finding a shoe to fit her right foot. Because of the numbness there is no pain, but noticed redness starting. She related no trauma but this foot change is worse. 15 Type I Diabetic with Charcot Foot (INITIAL EXAM) Assessment: 1. Charcot right foot 2. Type I Diabetic with neuropathy 3. Type I Diabetic with arthropathy 16 Type I Diabetic with Charcot Foot (INITIAL EXAM) Plan: 1. Order radiological studies to evaluate right foot 2. Order blood work-up to include Basic Metabolic profile and HgBA1C 3. Rx: Custom-molded shoes to accommodate right foot 4. Patient to return for follow-up in one week 17 Coding This Encounter Using ICD - 9 • Charcot right foot – 713.5 • Type I diabetic with neuropathy – 250.61 • Type I diabetic with neuropathic arthropathy – 250.81 • Polyneuropathy in diabetes – 357.2 18 Coding This Encounter Using ICD - 10 Code for Charcot right foot: 1. Go to chapter 13 – Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) 2. M14 – Arthropathies in other diseases classified elsewhere 3. Excludes 1: arthropathy in diabetes mellitus th (E08 – E13) with 4 character 6 19 Coding This Encounter Using ICD - 10 4. E10.6 - Type 1 diabetes mellitus with other specified complications 5. E10.61- Type 1 diabetes mellitus with diabetic arthropathy 6. E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy Type 1 diabetes mellitus with Charcot’s joints ICD – 10 Code for our Charcot foot: E10.610 20 Coding This Encounter Using ICD - 10 Code for type 1 diabetic with polyneuropathy: 1.Go to chapter 4 – Endocrine, nutritional and metabolic diseases (E00 – E89) 2.E10.4- Type 1 diabetes mellitus with neurological complications 3.E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy Type 1 diabetes mellitus with diabetic neuralgia ICD – 10 code for a type 1 diabetic with polyneuropathy: E10.42 21 Comparing ICD-9 and ICD-10 ICD-9 ICD-10 E10.610 Type I diabetic with Charcot’s 713.5 Charcot foot joints 250.80 Type I diabetic with neuropathic arthropathy E10.42 Type I diabetic with diabetic 250.61 Type I diabetic with neuropathy polyneuropathy 357.2 Polyneuropathy in diabetes 22 Coding This Encounter Using ICD - 10 The codes for this initial encounter of a type 1 diabetic with a Charcot foot would be: CPT: 99203 Initial visit ICD – 10: E10.610 Type 1 diabetes mellitus with Charcot’s joints E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy 23 Type I Diabetic with Charcot Foot (Subsequent Visit) Chief Complaint: Mrs. Smith is a 52 year old female who presents for a follow-up visit with numbness of both feet and a “fallen arch” on the right foot. History of present illness: She states that she noticed the change in her right foot over the last month. The numbness of both feet was present for 2 years but is progressively getting worse. The redness, especially in the midfoot area is increasing. She does not recall any trauma to the right foot. 24 Type I Diabetic with Charcot Foot (Subsequent Visit) Review of tests taken on initial visit: Radiological: X-rays taken on initial visit reveal degenerative changes in the midtarsal area of the right foot. Soft tissue swelling is also noted in the plantar aspect of the midfoot. These changes are consistent with a Charcot foot. Hematological: Blood work-up ordered on initial visit revealed the following abnormalities: Hgb. – 10.5; HgBA1c – 8.0; Glucose - 285 25 Type I Diabetic with Charcot Foot (Subsequent Visit) Assessment: 1. Charcot right foot 2. Type I Diabetic with neuropathy 3. Type I Diabetic with arthropathy 4. Anemia 5. Uncontrolled diabetes 26 Type I Diabetic with Charcot Foot (Subsequent Visit) Plan: 1. Fitted patient with custom-molded shoes ordered at initial visit. 2. Discussed with patient abnormal blood values. Called primary care provider and referred patient to him for further follow-up of the anemia and the poor glycemic control. 3. Discussed with patient proper nutrition as an aid to control blood sugar. 4. Rx: Metanx, one tablet, bid for one month – to help with the numbness of the neuropathy. 5. Patient to return for follow-up in two weeks. 27 Coding This Encounter Using ICD - 9 • Charcot right foot – 713.5 • Type I diabetic with neuropathy – 250.61 • Type I diabetic with neuropathic arthropathy – 250.81 • Polyneuropathy in diabetes – 357.2 • Acquired hemolytic anemia, unspecified - 283.9 • Abnormal glucose – 790.29 28 Coding This Encounter Using ICD - 10 E10.610 Type 1 diabetes mellitus with Charcot’s joints and E10.42 Type 1 diabetes with diabetic polyneuropathy are carried over from the initial visit. We now must code for: 1. Acquired hemolytic anemia, unspecified. 2. Abnormal glucose 29 Coding This Encounter Using ICD - 10 Code for acquired hemolytic anemia: 1. Go to Chapter 3 - Diseases of the blood and blood- forming organs and certain disorders involving the immune mechanism (D50-D89) 2. Then go to hemolytic anemias (D55 – D59) 3. D59.9 Acquired hemolytic anemia, unspecified Idiopathic hemolytic anemia, chronic 30 Coding This Encounter Using ICD - 10 Code for abnormal glucose: 1. Go to Chapter 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 2. R73.0 Abnormal glucose 3. Excludes1: diabetes mellitus (E08-E13) 4. Since we already have codes E10.610 and E10.42, we cannot use the abnormal glucose code. 31 Comparing ICD-9 and ICD-10 ICD-9 ICD-10 E10.610 Type I diabetic with Charcot’s 713.5 Charcot foot joints 250.80 Type I diabetic with neuropathic arthropathy 250.61 Type I diabetic with E10.42 Type I diabetic with diabetic neuropathy polyneuropathy 357.2 Polyneuropathy in diabetes 283.9 Acquired hemolytic anemia, D59.9 Acquired hemolytic anemia, unspecified unspecified 790.29 Abnormal glucose Included with E10.610 and E10.42 32 Coding This Encounter Using ICD - 10 The codes for this subsequent encounter of a type 1 diabetic with a Charcot foot and acquired hemolytic anemia would be: CPT: 99213 ICD – 10: E10.610 Type 1 diabetes mellitus with Charcot’s joints E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy D 59.9 Acquired hemolytic anemia, unspecified Idiopathic hemolytic anemia, chronic 33 TYPE I DIABETIC IN KETOACIDOSIS WITH OSTEOMYELITIS 34 TYPE I DIABETIC IN KETOACIDOSIS WITH OSTEOMYELITIS In this presentation, we will learn to code using the new ICD – 10 classification a patient who presents with: 1. Diabetes Type 1 2. Diabetic Ketoacidosis 3. Diabetic Nephropathy 4. Diabetic Neuropathy 5. Obesity 6. Ulceration of the right heel 7. Osteomyelitis of the right heel 35 TYPE I DIABETIC IN KETOACIDOSIS WITH OSTEOMYELITIS Consultation: Referring physician: Dr. XXXXXX Chief complaint: Mr. Jones is a 55 year old male who presents to the Emergency Room with an infected ulceration on the right heel which probes down to bone, a blood sugar of 500 and a temperature of 101.