Medical coding update from CIGNA

Diabetes with Manifestations

Diabetes Mellitus (ICD-9 code 250.00) is recorded when there is no mention ofcomplications.
Diabetes with Manifestations is a two-part code:
n Code 250.4X and 583.81 (nephropathy) for diabetes with renal manifestation
n Code 250.5X and 362.01 (retinopathy) for diabetes with ophthalmic manifestation
n Code 250.6X and 357.2 (polyneuropathy) for diabetes with neurological manifestation
n Code 250.7X and 443.9 (peripheral vascular disease/PVD) for diabetes with peripheral circulatory disorders
For patients that are prediabetic or borderline, use ICD-9 code 790.29, not a diabetic code.

Cancers with Metastasis Location 
If cancer spreads to another location, then both the primary and secondary areas should be recorded. Use ICD-9 code 199.1 when the location is unknown.

Coding Example: A patient is diagnosed with breast cancer. The physician records ICD-9 code 174.9 for the primacy cancer. Several months later, the patient’s cancer spreads from the breast to the liver. The physician should record ICD-9 code 197.7 as the secondary cancer, in addition to the primary cancer diagnosis.

History of Cancer  

If a patient is still receiving cancer treatment, code the active cancer code(s). Once the patient is no longer receiving cancer treatment and/or the cancer has been excised from its site, code the history of malignant neoplasm.
V10.3 = history of breast cancer
V10.46 = history of prostate cancer

Rheumatoid Arthritis 
ICD-9 codes vary depending on the patient having arthritis or rheumatoid arthritis.
ICD-9 code 714.0 has been established specifically for patients with rheumatoid arthritis.
 
Chronic Hepatitis C 
Use ICD-9 code 070.54 for patients that are diagnosed with chronic Hepatitis C.

Alcohol & Drug Dependence 

ICD-9 code 305.XX represents non-dependent abuse of alcohol. This includes cases where the patient may be a binge or recreational drinker, but is not dependent on alcohol.
 
ICD-9 codes 303.9X should be assigned to patients that are dependent on alcohol.
Select one of the following codes based on the degree of dependency:
 303.90 = alcohol dependence unspecified
 303.91 = alcohol dependence continuous
 303.92 = alcohol dependence episodic
 303.93 = alcohol dependence in remission
 
ICD-9 code 304.XX should be utilized for drug dependence

CVA (Stroke) & Late Effects 

It is common for a patient to suffer additional conditions, called late effects, after having a stroke. Examples of late effects include Hemiplegia/Hemiparesis, Aphasia, Dysphasia, Ataxia, and Dysphagia. Separate ICD-9 codes have been established in order to document this occurrence.
 
Coding Example: A patient has a stroke/CVA with cerebral infarction. ICD-9 code 434.91 would apply to this scenario. After the initial episode, the patient suffers from Hemiplegia as a result of the stroke. In this case, use ICD-9 code 438.20. ICD-9 code 436 (acute, but ill-defined, cerebrovascular disease) should not be used when the documentation states stroke or CVA

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