INTRODUCTION
DEFINITION: In simple words increased blood glucose level is known as diabetes mellitus
It is commonly reffered as diabetesIt is a group of metabolic diseases.Major symptom of DM is frequent
urination(polyurea) and increased thrist(poly dipsia)
TYPES OF DIABETES
MAINLY CLASSIFIED INTO 3 TYPESTYPE-1 DM:insulin dependentTYPE-2 DM:insulin resistant GESTATIONAL DIABETES
this type of DM observed in pregnacy women without any previous history of diabetes.
SIGNS& SYMPTOMS
INCREASED URINATION INCREASED THRISTINCREASED HUNGER(APPETITE)FATIGUESKIN RASHES
CAUSES
In type-1 diabetes due to auto immune attack destruction of b- cells of pancreas.
Hence type-1 DM is idiopathictype-2 diabetes results from defective
responsiveness of body tissues to insulinGestational diabetes involving a combination
of relatively inadequate insulin secretion and responsiveness
COMPLICATIONS
CARDIOVASCULAR DISEASESDIABETIC FOOT PROBLEMSSTORKE DIABETIC RETINOPATHYDIABETIC NEPHROPATHYPERIPHERAL VASCULAR DISEASES
DIAGNOSIS
BLOOD LIPID LEVELSHbA1C TESTFASTING BLOOD GLUCOSE LEVELS
Normal<100mg/dlORAL GLUCOSE TOLERANCE TEST
Normal<140mg/dlRANDOM BLOOD GLUCOSE LEVELS
Normal<200mg/dl
MANAGEMENT
Pharmacological treatmentFor type-1 diabetes-insulinIn type-2 diabetes drugs likeSulfonylureas class:
ChlorpropamideTolazamidetolbutamide
Short acting insulin agents like:Repaglinide Nateglinide
Biguanides class:Metformin
Thiozolidinediones class like:Pioglitazonerosiglitazone
NON PHARMACOLOGICAL TREATMENT
DIET AEROBIC EXERCISESAVOIDING ALCOHOLCESSATION OF SMOKING
Diabetes codes in ICD-10-CM are combination codes, includes · Type of diabetes · Body System Involved · Complication
Example: E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with
macular edema E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
Ø If the type of diabetes is not mentioned in the documentation, query the physician or assign the code E11.-
Ø Assign the code Z79.4 for long term use of insulin Ø If insulin is given on temporary basis, don’t assign the code Z79.4
ICD-10-CM 2017 The first major change in ICD-10-CM codes for 2017 is for diabetic
ocular complication coding. All of the DM retinopathy code choices will now specify which eye is impacted. Several new codes for proliferative diabetic retinopathy were also added.
· Laterality is now a component of all diabetic retinopathy and macular edema codes.
· For patients who routinely use insulin or hypoglycaemic drugs, code Z79.4, Long-term (current) use of insulin, or Z79.84, Long term (current) use of oral hypoglycemic drugs should also be assigned.
· If a patient is on both oral medication and insulin, both of these medication codes should be used
E10.32 Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy Type 1 diabetes mellitus with nonproliferative diabetic retinopathy NOS
One of the following 7th characters is to be assigned to codes in subcategory E10.32 to designate laterality of the disease:
1 - right eye2 - left eye3 - bilateral9 - unspecified eye
You will also note that ICD-10 codes E11.35 used for Type 2 diabetes mellitus with proliferative diabetic retinopathy (E11.351 = with macular edema; E35.359 = without edema) has been greatly expanded.
E11.35 Type 2 diabetes mellitus with proliferative diabetic retinopathy
One of the following 7th characters is to be assigned to code E11.35
1 = right eye2 = left eye3 = bilateral9 = unspecified eye
It is very important for the coder to analyse the documentation and clinical scenario.
Physician may need document the following to assign the code E08.01
1) Cause for Diabetes Mellitus2) Use of Insulin3) Level of blood sugar4) Dehydration5) Comatose condition
Prediabetes (R73.03)
Prediabetes was previously classified to R73.09 Other abnormal glucose. The new code R73.03 uniquely identifies patients with prediabetes so that this condition can be tracked. The American Diabetes Association® defines prediabetes as one of the following abnormalities when blood glucose or A1c level is tested:
• An impaired fasting glucose (IFG) • Fasting blood glucose of 100-125mg/dL • Impaired glucose tolerance (IGT) • Blood glucose of 140-199mg/dL 2 hours after a 75g oral glucose
tolerance test (OGTT) • A hemoglobin A1c (A1c) value of 5.7-6.4%
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