Diabetic Manifestations Coding — DM Coding

Diabetic Manifestations Coding — DM Coding http://www.cco.us/cco-yt

Alicia: Yes, the diabetic manifestations. I really enjoy DM coding, I don’t know why. What are they and how can I recognize them in a chart? It’s one thing to have diabetes but if you didn’t know, diabetics tend to have other organ problems because it affects the entire body. And there’s a few manifestations that you need to be aware of. The first one you’re going to see is renal manifestations which means anything that’s happening to your kidneys, your urinary tract. So your kidneys, your bladders, your bladder, not bladders. People with CKD or Chronic Kidney Disease, they can get that because they are diabetic. These are just… this microalbuminuria, that just means they’re spilling this protein type thing. Proteinuria means they’re spilling protein. And nephropathy, not to be confused with neuropathy. This is nephropathy so that’s the kidneys.

The labs, you’ll see with people that have renal manifestations are going to be BUN, creatine and CMP. The creatine, you see almost always they’re checking in diabetics. They’re constantly checking their creatine level. Another thing you’ll see is they’ll be on dialysis. And you know, they wouldn’t have to be on dialysis if they didn’t have renal function problems because of their diabetes. And that is V45.11. You’ll have to code that pretty often with… if your person’s having dialysis.

250.5, ophthalmic manifestations. When you have diabetics that start having problems with their eyes, they get cataracts and glaucoma. Retinopathy, blindness. It’s very common to have problems with your eyes if you’re diabetic. And I remember when I was working for medical records, I went to work one day and I kept looking at the clock across the room and it was blurry. It wasn’t the day before and then it was and it was just… I just knew there was something wrong with my sugar.

And I went to the doctor and I was telling all the nurses. And one of the doctors finally told me, he said… because if you’re in medical records, they’re at your fingertips. You can ask them, you know? And they said you know, if it was affecting your eyes, if you’re having problems with your sugar and it was affecting your eyes, it’s already too late. And he said, “You know, you should just consider that it’s time to get glasses.” And that was actually the problem. But you’ll see that they’ll have eye drops. But you know, I was just telling them, it’s not that I’m getting older. I just… I can’t see anymore.

Ophthalmic conditions or consultations that… if a diabetic is having problems with their eyes, say they’re… things are starting to look foggy because they’re getting cataracts, they’re going to send them straight to an ophthalmologist to have that checked because the PCP isn’t going to follow them for ophthalmic conditions. So you’ll see these consultations.

Neurological manifestations, 250.6. This is where you know, this is your nerves. So people who have problems, they’re diabetic, they have… their feet ache, their hands ache. Their feet are always cold. They get tingling sensations and stuff. That is because of the neuropathy and that’s… you know, in my opinion, that’s one of the first things to go.

Now I could be wrong but as I’m reading charts and stuff of geriatric patients, it seems like… if they’re diabetic, the first things to start going is the neurological manifestations. But what some people don’t realize is this gastroparesis, that you know, that is actually… if you break the word down, gastro is your stomach or your intestines and it paralyzes parts of your digestive system. And it’s all because it’s neurological. It’s nerves. I just learned that at a webinar the other day. I had never thought about that.

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