Endocrine Part 2-Gestational and Pre-Existing Diabetes in Pregnancy Coding

Jul 13, 2024

Gestational and Pre-Existing Diabetes in Pregnancy Coding

Overview

  • Importance of using guidelines to identify and code for gestational and pre-existing diabetes accurately.
  • Employing insulin and diet management for blood sugar control.

Key Points

  • Look for the subcategory 4 02 4.4 which indicates gestational diabetes.
  • Gestational Diabetes: Diabetes that occurs during pregnancy and managed using insulin and diet (not oral hypoglycemics).
  • Pre-Existing Diabetes: Diabetes that existed before pregnancy.

Guidelines

Gestational Diabetes Coding

  • Guideline C4 A4 and C15 point I: Guidelines for coding gestational diabetes.
  • Reference: Code Z79.4 for insulin use.
  • Do not code insulin additionally with subcategory 02 4.4.
  • Code 0244.4 for gestational diabetes managed by insulin.
  • Do not use Z79.4 (insulin) with 02 4.4 – that’s a guideline restriction.

Example

  • Situation: 25-year-old OB patient, 29 weeks pregnant, uses insulin and diet.
  • Correct Code: 02 4.41 for insulin-controlled gestational diabetes.
  • Example Code Assessment:
    • B: Incorrect (uses Z79.4 with 024.4)
    • C: Incorrect (uses Z79.4 with 024.4)
  • Correct Answer: A 02 4.4 Z3 a. 29

Sequencing in Pre-Existing Diabetes with Pregnancy

  • Pre-Existing Diabetes: Use Guideline C4 A4 for pre-existing diabetes sequencing.
    • Sequence: First 02 4.1, then diabetes code (e.g., E11.9 for type 2), and finally insulin code (if applicable).
  • Example: 30-year-old 11 weeks pregnant patient with type 2 diabetes, insulin prescribed.
    • Correct Code: 0241.111
    • Trimesters: 1st trimester is <14 weeks.
    • Correct Answer: B 0241.111 E11.9 Z79.4

Identifying Insulin in Diabetes (Non-Pregnancy)

  • Guidelines: C4 A2, C4 A3 for coding diabetic treatment methods (e.g., Insulin, non-insulin injectable like Trulicity).
  • Insulin identifiers: Log, Lyn, and others (e.g., Humalog, Novalog)

Example

  • Situation: 36-year-old male, diabetes managed by Lanis (insulin) and Trulicity (non-insulin injectable).
  • Importance of non-insulin identifiers for correct coding.
  • Correct Answer: C E11.9 Z79.4 Z79.85

Summary

  • Use guidelines meticulously to identify and code for gestational and pre-existing diabetes correctly.
  • Sequence codes based on type of diabetes and how it's managed.
  • Recognize insulins and non-insulin injectables for proper coding.

Takeaways: Apply specific ICD-10 coding guidelines, identify diabetes type, and correctly sequence with regard to insulin or non-insulin treatments.

Happy Coding!