[Music] ch ch [Music] [Music] [Music] ch [Music] [Music] oh [Music] [Music] all right so the patient uses insulin and diet to manage her blood sugars a you know what I don't like the way this looks this looks like a zero it does look like a zero but it's not all right a2444 Z3 a29 B 02445 z79.4 z79.84 Z3 a. 29 c 024 . 414 z79.4 Z3 8.29 and D O2 4.41 9 z79.4 z79.84 and Z3 a29 coders do you all see something crap in the chat what do you see what do you see in the answers that's why why we read the answers first so it can give us some information right anybody notice something in the answers somebody's answering the question don't answer the question yet I want to know what you see all right so maybe you don't see it yet but you will but all of these have subcategory 4 02 4.4 that means this is a gational diabetes scenario a 20 5-year-old OB patient with gestational diabetes and 29 weeks pregnant arrives for a routine prenatal visit the patient's blood sugars are normal the patient uses insulin and diet to manage her blood sugars okay coders somebody coded it straight away they said we don't know what you're talking about Mrs Jay the answer is what say you I guess my little clock doesn't want to work it's okay go ahead put your answers in the chat all right make sure you go grab the guideline what's the guideline that's right somebody said I'm about to look at it I know that's right let me see I want to I wish I could see um the full you all are saying some great things but I can't see everything if you make short comments I can see it but not long ones so I do apologize for that all right so grab your guideline tell me which guideline you referenced yes yes yes good job good job good job all right so the guideline is going to come up on the next page but our key wordss gestational diabetes 29 weeks insulin and diet and we know this is gestational diabetes because we just studied how to identify them and we're going to code for gestational diabetes and this patient's on insulin and diet not oral hypoglycemic I got caught let's go back I want to make sure it's on there nope all right so guideline C4 A4 it's the same as that C15 point I yeah we're going to reference the guidelines for gestational diabetes all right so there's some key language in there and it tells you it outlines if a patient is on um you know if it tells you how to which code to select if the patient has um gestational diabetes and their diabetes is being managed using insulin diet medications Etc so this language here kind of helps us determine how to sequence things and so when you have gestational diabetes I further clarified the MC G manual so if you have an mcg manual you don't have the green language I suggest that you put it in because I think it clarifies it a little more here's why if you have insulin you use code 0244 one4 or if the patient um diabetes is controlled by diet and Insulin you use that same code the same is true for oral hypoglycemics or diet and oral hypoglycemics they use the same code so I got that from this language in the middle so they don't really code um when a patient is using both they code the higher of the two when it comes to diet and insulin or diet and hypoglycemics so if you want to change your language go right ahead so knowing this language it gives us an advantage right sort of right well if you look below where it says codes z79.4 that's your insulin z79.84 and z7 9.85 should not be used with a code from 02 4.4 make sure you put the point 4 there you do not code insulin in addition to this Cate this subcategory don't do it go ahead and write it in 04 that subcategory we're nailing this today all right so if that's the truth we got a lot of wrong answers here look at b b is wrong it's coding z79.4 for with this O2 4.4 subcategory it's also coding z79.84 you cannot do it the guideline says you can't look at C wrong too it's coding the insulin with that subcategory and so too is D so look at your answer but a is the answer but let's go ahead and do our due diligence right yeah let's take a look let's put our eyes on these codes so if we go to 024 subcategory 0241 and if you look at 02445 B this is the code for gestational diabetes militis in pregnancy controlled by Oral hypoglycemics this is not pertinent to our encounter our patient patient taking insulin so B got to go O2 4.49 found that D gestational diabetes metis in pregnancy unspecified control nope we know how this diabetes is being controlled our documentation says it's being controlled by use of insulin so D is incorrect as well now O2 4.41 for this is correct gestational diabetes metis and pregnancy insulin controlled so we can use it so the biggest point that I want to make if a patient is using insulin along with diet you only code the insulin code and I do want to point out that there is a diet controlled code too 0244 one0 but you only use it if the insulin if the um diabetes is being made managed by diet only so B has to go D has to go C's going and our answer is a 02 4.4 Z3 a. 29 okay coders how you doing you doing good yes I saw all those A's in there I was so happy you know what I I don't think I can see your answers anymore all right good job coders let's go ahead and let's knock this next one out got another pregnancy a 30-year-old 11 weeks pregnant patient oh no no no sorry forgive me select the correct answer a 02 4.41 4 Z3 a11 b 0241 one1 e11.9 z79.4 z 38.1c 02412 e11.9 z79.4 Z3 a11 and D O2 4.41 4 e11.9 z7 9.4 Z3 a11 a 30-year-old 11 weeks pregnant patient who has diabetes metis arrives for a routine prenatal visit the patient's blood sugars are normal the patient uses insulin to control the diabetes select the correct answer okay coders what say you your time begins now okay coders I think this is going to be a aha moment for a lot of people yeah I don't see too many answers in here a lot of people stumped saying hey I don't know if that's gestational or pre-existing right all right so this is 11 weeks pregnant patient patient has diabetes militis patient uses insulin coders this is pre-existing if it was gestational the documentation will say gestational diabetes it will indicate that the pregnancy caused the diabetes all right so just so you know the documentation has to specifically say that it is gestational diabetes or the the pregnancy caused the diabetes all right and in that case this is pre-existing diabetes in other words this diabetes pre-existed prior to the pregnancy and we're going to use C4 a.4 someone said it in the chat you rock and we're going to sequence in the following way we're going to sequence first 02 4.1 followed by your diabetes code and third your insulin code if applicable coders can we eliminate anything on site in fact we can right we can eliminate what on site on site we can eliminate A and D because look at that four look at that pregnant just stational four this insulin existed this insulin this diabetes metis in existed first before the pregnancy I got a new thing that one means first that one in the subcategory section means first this is applicable to our scenario so we are going to get rid of A and D because this is not pre-existing this excuse me this is not gestational diabetes malius all right so it leaves us with b and c so the guideline that I'm going to use is that C4 A4 just applies all the way around and there's no way we can tell the correct code based upon the guidelin so we have to look up up the code let's go ahead and do it all right 0241 category this is pre-existing type two diabetes mtis and pregnancy child birth and the perum also the second code is our Diabetes Type 2 not specific also the third is z79.4 this is our long-term use insulin and you know what we need to know we need to know the trimester we need to know which trimester we're in why because the code at 2411 subcategory 111 is for first trimester and 112 is for the second trimester and we have to know the trimesters according to icd10 CM so the ICD tum trimesters and it says the first trimester is Le less than 14 weeks zero days so this patient is in her first trimester so we're going to use the first trimester code 0241 one1 so we're going to eliminate C and our answer is B how you doing coders I see some aha moments going on in the chat somebody said they're fine that's right good deal somebody said I'm great somebody said I'm okay hey I got you I got you and you know what you can always look at these playbacks so make you know definitely make good use of them all right right so now we're going to leave our discussion on um diabetes and pregnancy and I want you to just remember that pre-existing means the diabetes existed first or prior to the pregnancy gestational is caused by the pregnancy or the gestation and you're going to sequence you're pre-existing like this 02 4.1 one in the fourth character space means first and you're also going to code for your type of Diabetes you're going to code for your insulin if applicable and you can and also your week's gestation whereas gestational diabetes you use 02 4.4 subcategory and remember I'mma let that marinade all right coders are you ready to continue our discussion let's learn about some more guidelines oh yeah someone has a good good point they said hey if gestation isn't documented if gestation is not documented you are correct then it is pre-existing okay alrighty question number five select the correct answer a e10.9 z79.4 b e11.9 z79.4 c e11.9 z79.4 z7 9.85 and d e11.9 z7 9.85 a 36-year-old male patient visits the clinic for a routine follow-up appointment for his diabetes mtis he has been managing his condition with both lanis 20 units subcutaneously daily and trulicity 75 um milligrams subcutaneously weekly all right coders what say you your time begins now all right coders I think the best a lot of these guidelines seem to be jumbled I can tell because um you all are applying guidelines for certain circumstances so my advice don't try and commit that to memory grab your guidelin and apply your guideline and follow that guideline until you know it right you all are rocking and rolling good job all right I'm G to wait for a few more people to put their answers in the chat make an educated guess based upon the guidelines good job good job good job all right coders all right so this patient has diabetes malius right and they're taking this less and they're also taking trulicity but coders when the documentation says that the patient has diabetes mtis what type is it what is the default go ahead type in the chat yeah it's type two so if the doctor doesn't specify type one you do not document type one all right just thought I would tell you that all right so just so you know the guideline one of the guidelines I'm going to reference is C4 Point A3 but I realize that you all may not be able to determine if insulin is being used or not is trulicity insulin insulin is lanis insulin or lantis insulin okay well let's address that but before I do that I just want to let you know that lantis is insulin and TriCity is not insulin it's an injectable but it's a noninsulin inject rejectable well how do you know that Mrs Jay well I did some research and I looked up the common insulin Brands yeah and so they are kind of you have different um insulins for different purposes so you have this rapid acting short act acting intermediate acting long acting insulin mixtures it doesn't matter what matters is is that you're able to identify if insulin is being used or not so I looked at this list and I said okay how am I going to get them to recognize insulin how are they going to identify insulin on site well you see these logs Huma log adal log Nova log right you see these lens humin um novalin right and then you've got humin novelin Humalog Humalog novalog so you got these logs where the um suffix is a log or Lyn then it's nine times out of 10 an insulin and then you have all the others in between but it's not a lot you have that um Li moav aidra afza levir lantis bazlar toio Sly trba and you know what I did I wrote them right here here you go here are your common insulins it's going to end with the log or Lyn a log or a Lyn or all these others here on the list that's the best I can do coders it's not that big either right so if you want to screenshot it go ahead boom you want to wait for the playback it'll be there okay so that's what I recommend that you do put that in your in your book well I will put it in the MCG manual then go ahead and put it in when you tap tap it in your book just saying all right so guidelin C4 A3 is applicable and so is C4 A2 now let's get to it all right so let's look at guidelines C4 A2 when the type of diabetes malius is not documented you code it as type two right e11.6 so we're eliminating a because a is e10.9 that's type one also when you have insulin and oral hypoglycemics and noninsulin injections you have to coat it a certain way and the coding instruction is at C4 A3 and if you go over to the um third column it says when the patient treated with insulin and injectable a non-insulin injectable that's trulicity and also two coers see where it says subcutaneously that means they are injecting it into the skin and down to the subcutaneous level right so we know Lance was on our list that's insulin and trulicity is not on the list so it's got to be a non-insulin injectable so how we code it we have to code z79.4 for the insulin and z7 9.85 and just so you know coders when you are coding regular diabetes type two you code everything if a patient has oral hypoglycemics non insulin injections and Insulin you cat it all and that's when they have Diabetes Type 2 we're not talking about pregnancy all right so we're going to eliminate a because it's coding for the wrong type we're going to eliminate B because they're not coding for the trulicity they're only coding for the insulin we're going to eliminate the because it's only coding for the non-insulin injectable trulicity and C is our answer how are you coders you all kind of quiet I need to know how you're doing all right somebody said okay somebody said great somebody else said great somebody said good somebody said I got it now awesome somebody said I'm learning Priceless okay all right so it's just a matter of you just looking at the guidelines and just looking at them more than once and it's going to make sense thanks for tuning in and until next time happy [Music] coding