Alicia: Yes, the diabetic manifestations. I really enjoy dm coding, I donít know why. What are they and how can I recognize them in a chart? Itís one thing to have diabetes but if you didnít know, diabetics tend to have other organ problems because it affects the entire body. And thereís a few manifestations that you need to be aware of. The first one youíre going to see is renal manifestations which means anything thatís 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 justÖ this microalbuminuria, that just means theyíre spilling this protein type thing. Proteinuria means theyíre spilling protein. And nephropathy, not to be confused with neuropathy. This is nephropathy so thatís the kidneys.
The labs, youíll see with people that have renal manifestations are going to be BUN, creatine and CMP. The creatine, you see almost always theyíre checking in diabetics. Theyíre constantly checking their creatine level. Another thing youíll see is theyíll be on dialysis. And you know, they wouldnít have to be on dialysis if they didnít have renal function problems because of their diabetes.
And that is V45.11. Youíll have to code that pretty often withÖ if your personís having dialysis. 250.5, ophthalmic manifestations.
When you have diabetics that start having problems with their eyes, they get cataracts and glaucoma. Retinopathy, blindness. Itís very common to have problems with your eyes if youíre 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 wasnít the day before and then it was and it was justÖ 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 saidÖ because if youíre in medical records, theyíre at your fingertips. You can ask them, you know? And they said you know, if it was affecting your eyes, if youíre having problems with your sugar and it was affecting your eyes, itís already too late. And he said, ìYou know, you should just consider that itís time to get glasses.î And that was actually the problem. But youíll see that theyíll have eye drops. But you know, I was just telling them, itís not that Iím getting older.
I justÖ I canít see anymore. Ophthalmic conditions or consultations thatÖ if a diabetic is having problems with their eyes, say theyíreÖ things are starting to look foggy because theyíre getting cataracts, theyíre going to send them straight to an ophthalmologist to have that checked because the PCP isnít going to follow them for ophthalmic conditions. So youíll see these consultations. Neurological manifestations, 250.6. This is where you know, this is your nerves. So people who have problems, theyíre diabetic, they haveÖ their feet ache, their hands ache. Their feet are always cold.
They get tingling sensations and stuff. That is because of the neuropathy and thatísÖ you know, in my opinion, thatís one of the first things to go. Now I could be wrong but as Iím reading charts and stuff of geriatric patients, it seems likeÖ if theyíre diabetic, the first things to start going is the neurological manifestations. But what some people donít realize is this gastroparesis, that you know, that is actuallyÖ if you break the word down, gastro is your stomach or your intestines and it paralyzes parts of your digestive system. And itís all because itís neurological. Itís nerves.
I just learned that at a webinar the other day. I had never thought about that. Another thing is if youíre having neurological problems, youíre going to see amputations.
So you know, they usually start out with the toe. And pretty soon, theyíve had 2 toes taken off. The next thing you know, theyíre getting amputated at the knee.
So you know, be aware of that. Those are the 3 common drugsÖ that Neurontin, I see that all the time with neurological manifestation. And when youíre looking at the charge, look for the review of systems and then the HPI. Youíre going to see the tingling, numbness, pain in the hands and feet. And evenÖ there was another one that I saw the other day. I canít think of it.
The 250.7, peripheral circulation disorders. Now the neurological remember, is doing the nervous system. Okay but now, weíre getting into the circulatory system and this, I think, happensÖ I would say, if they didnít have neurological problems, peripheral is going to be either first. PVD, claudication, gangreneÖ and thatís when they start losing their toes. Theyíre not getting any oxygen to those extremities.
And thus youíve got amputations, atherosclerosis. Youíre going to see them do an AVI, angiographic doppler studies, ultrasounds. Theyíre going to be taking their cholesterol and their triglycerides. Because if you already have problems and then you have high cholesterol you know, if these veins are not working properly and theyíre getting backed up you know, if you have cholesterol problems, that justÖ it just makes it worse. Medications that youíre going to see people with peripheral circulation disorders and Iím not even going to try to pronounce that first one. Trental or letís see, aspirin or heparin, Warfarin, Coumadin, Lovenox.
All of those on that line are blood thinners. And so youíre going to see them onÖ theyíre thinning the blood so it flows better so that they can get the oxygen to the extremities so these tissues donít die. Thatís exactly what it does. It just kills the tissue because thereís a lack of oxygen.
These are anti-platelet, anti-coagulants and thrombolytics. Ultimately, theyíre blood thinners. Your extremities will have decreased pulses. So when youíre doing that review of systems and theyíll say you know, decreased pedal pulses means that you know, when they touch you on the top of your foot and he holds your foot, heís checking to see if your feet are cold. But heís also checking those pulses to see claudication. It kind of means you have a limp. Coldness, your feet will be very, very cold.
You canít get your feet warm no matter what you do. Cramping in the calf, numbness and weakness. These are all side effects that are a big heads up for people. If you have these problems and youíre diabetic, you definitely want to go see the doctor because youíre having problems.
Was there another one after that? Yeah, the 250.8. Thatís other specified manifestations. Now all of the ones that are above that, everything before 250.8, I found out today in a webinar that I was in, those end up being chronic.
So once you have a neuropathy, itís not going away. Now, if you knowÖ so once you start having ophthalmic problems, all of those, theyíre considered co-morbidities. And once youíve got them, youíve got them. Youíre not going to get rid of them. You just have to treat them. Unlike 250.8. Now thatís kind of a like a little fringe of diabetic problems.
These can be treated. If you have hypoglycemia and youíve got weakness, confusion, slurred speech, that can be treated because you can usually take care of that with your diet. Osteomyelitis, antibiotics, skin ulcersÖ you know, people are going to have problems withÖ you want to look up osteomyelitis? Laureen: No I justÖ correct the spelling.
Alicia: Oh sorry. I did those pretty fast. Skin ulcer, youíre going to see when theyíre bedridden, of course, theyíre going to get decubitus.
But pressure ulcers on their feet, youíre going to see a lot of wound care. Letís see, so with all of these diabetic codes, you would use in addition the manifestation code. So if you wereÖ if your person was diabetic and they got osteomyelitis, they would no longer be 250.00. They will be 250.80 because they have osteomyelitis and then you would code the osteomyelitis on top of that or after that. Same thing withÖ if your diabetic personís been coming into the office you know, routinely having their feet checked and stuff like that. And then all of a sudden, they came in with a pressure ulcer on their left foot, heís no longer a 250.00. Heís a 250.80 and then you code the pressure ulcer as well.
Same thing with those others with the neuropathy and stuff like that. Thatís why you want to be very aware of coding. If you donít code 250.80 and you code 250.00, youíre not coding to the highest specificity. And also, your doctorís not going to get paid as much because whatís paid out for .80 and .00 is two different amounts. So you want to make sure youíre very aware of that when youíre coding. And the doctor probably is not going to type in or when he writesÖ if he writes codes, heís not going to write 250.80. Heíll put 250.00. Itís up to you to use the code or to know, if itís an .80 if they have a pressure ulcer.
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