Tips for Endocrinologist to Ensure Proper ICD-10 Coding
The expansion of diagnosis codes with ICD-10 makes the endocrinology medical coding process more complex. Endocrinology providers should have a better knowledge about the endocrine system and much more detailed documentation to choose the most appropriate codes. Specificity is very important when it comes to data quality, medical necessity, and reimbursement. Here are some effective tips for endocrinologists to prepare well for ICD-10 coding and avoid claim denials or drop in reimbursement. Some of the crucial diagnosis in this specialty and their coding are as follows:
Diabetes
In order to select the correct ICD-10 code for diabetes, your documentation should include the following:
Identify the type
Clarify and cause and relationship with other conditions
Specify whether any organ system is affected, any complications, and long term use of insulin for type II diabetes
Details about insulin underdosing or overdosing as a result of an insulin pump malfunction (if it occurred)
Underlying condition, drug or chemical responsible for secondary diabetes
Distinguish whether diabetes is accompanied by “hypo” or “hyper” glycemia and state if hypoglycemia is or is not causing a coma
The basis ICD-10 codes for diabetes mellitus are as follows:
E08 - Diabetes mellitus due to underlying condition
E09 Drug or chemical induced diabetes mellitus
E10 Type I diabetes mellitus
E11 Type 2 diabetes mellitus
E13 other specified diabetes mellitus
These codes are further elaborated according to the varying characteristics of diabetes mellitus. Some examples are:
E08.0 Diabetes mellitus due to underlying condition with hyperosmolarity
E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma
E08.1 Diabetes mellitus due to underlying condition with ketoacidosis
E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma
E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma
Also, you are required to report additional codes to specify any underlying conditions, insulin use, specific stage of chronic kidney disease, exact site of any diabetic ulcer (anatomical location and laterality) and severity, poisoning due to drug or toxin, or specific drug or toxin that causes the adverse effect. This is why detailed documentation with aforementioned components is essential.
Endocrine and metabolic disorders
Your documentation should include the following for correctly coding endocrine and metabolic disorders:
State the specific disorder, disease, defect, deficiency or syndrome
Identify any underlying condition
Specify the significance of any abnormal lab findings
Give details on disorders such as being congenital, hereditary, primary, idiopathic, secondary, pseudo, and familial if applicable
For metabolic disorders, you should specify the amino acid, carbohydrate, or lipid enzyme deficiency that contributes to the disorder. The ICD-10 codes for endocrine and metabolic disorders are as follows:
E25.0 Congenital adrenogenital disorders associated with enzyme deficiency
E25.8 Other adrenogenital disorders
E25.9 Adrenogenital disorder, unspecified
E30.0 Delayed puberty
E34.3 Short stature due to endocrine disorder
E23.0 Hypopituitarism
E30.1 Precocious puberty
E30.8 Other disorders of puberty
You should state the specific vitamin and/or mineral to assign correct codes for vitamin/mineral or other nutritional deficiencies. Document any symptoms of premature menopause (flushing, sleeplessness, headache or lack of concentration) since this affects coding. If a patient presents with gout, you should document the cause, episode, location and with or without tophi (in case of chronic gout). ICD-10 provides codes for iodine-deficiency-related goiter. You should document those conditions properly to report them using the correct codes, when applicable.
Endocrinologist may use the EHR system to tackle the increased complexity with ICD-10 to a certain extent. If you have already implemented such a system, make sure that your templates are updated for the ICD-10 coding system.