Question:
CarolB: What is the proper code for a diabetic with ketoacidosis due to a malfunction of an insulin pump, the pump failed to deliver insulin causing ketoacidosis?
Answer Thread:
Luna:
(*appropriate 5th digit for type of DM)
Guideline reads:
" Underdose of insulin due to insulin pump failure: An underdose of insulin due to an insulin pump failure should be assigned 996.57, Mechanical complication due to insulin pump, as the principle or first listed code, followed by the appropriate diabetes mellitus code based on documentation."
I am not sure an E code is necessary as the sequencing of the two other codes already completes the story. Patient's insulin pump failed resulting in ketoacidosis. An E code is usually used in the case of poisoning or an overdose. But this does not fall under overdose. This is an underdose if the "pump failed to deliver insulin, causing ketoacidosis.
Of interest too, is if a pump delivered too much insulin, resulting in a complication then the guidelines (Section 1.C.3.6.b) instruct:
"Overdose of insulin due to insulin pump failure: The principal or first listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be 996. 57 Mechanical complication due to insulin pump, followed by 962.3 Poisoning by insulins and antidiabetic agents, and the appropriate diabetes mellitus code based on documentation."
So, as far as it looks, neither incident requires an E code.
I'm an early student and may be in error. I've been Googling to find out if an E-code is required and if I find something more helpful or that confirms one way or other I'll be sure to share.
CarolB: But would't there be an ecode for the malfunctioning insulin pump as a device causing a problem?
Lori Woods: E932.3 insulin & anti-diabetic agents might be what you are looking for.
Luna:
My thought though was that the E932.3 code is essentially saying patient was getting the "correct drug properly administered in therapeutic dosage" (quoted from the category guidelines), but had an adverse reaction of effect to it.
However, the patient actually was not receiving the correct dosage and that is what caused the ketoacidosis. Ketoacidosis was not a reaction the patient had to the insulin, it is the result of not getting the insulin. Thus the code 996.57, Mechanical complication due to insulin pump tells there was a problem with the pump not administering the med, and code 250.1* Diabetes with ketoacidosis tells what it resulted in.
That was the thing that stumped me about using this E code. I think this E code is saying the insulin caused an adverse effect.
Lori Woods: Luna I thought since you already addressed the device malfunction they were asking for any E code regarding the insulin taken properly but ending up being an overdose because of it. I misunderstood I guess.
Luna:
I also think the sequencing is the diabetic code (250.1*) followed by the failed mechanics code 996.57 since it states "Due to". So it pretty much tells the complete story that patient is "diabetic with ketoacidosis" "due to failed insulin pump".
Lori Woods:
Yes, that was the only thing I could find & I wouldn't have assigned it either. I would have coded it the same as you.
Luna:
And my bad, but I think I'm wrong on the sequencing in my last comment. The guidelines state to code the failed pump as first listed followed by the appropriate diabetic code. (If I think too long I get all twisted around. LOL)
CarolB:
Ok, this is what I am looking for the Insulin pump malfunction so I want an ecode for device malfunction much like when a pacemaker malfunctions the codes are 996.01 with ecode e878.1, I just am not sure what type of device this Insulin pump would go under as far as ecodes.
Lori Woods:
Lol I have to really watch what I say too that one word you don't include in your coding or don't say when talking about it. That's why talking about it hopefully my detail orientation will improve meaning I would code it as the insulin pump failure & of course the diabetic due to Ketoacidosis. But then when you talk about other codes with others you can see different sides on why or why not you would or wouldn't include other things. I believe the 250.1 covers the inadequate drug because it basically said the failure to deliver the insulin caused the ketoacidosis ( I also have to watch my spelling wrong spelling can change stuff too ). The original statement led me to believe they knew the other codes but was curious about possible E codes. And then I misread overdose not underdose when I suggested the E code. I was just thinking if they had received the proper amount of insulin intended which would have been therapeutic. You see how my mind wanders & then I question my choices lol.
Lori Woods:
I believe Luna is correct only code 996.57 would be used to cover this.
Carolyn Heath:
The codes are as follows and in order according to the guidelines:
996.57 - malfunction of insulin pump (to find the code: complications, insulin pump)
250.10 - diabetes with ketoacidosis (to find the code: diabetes, ketoacidosis)
Normally, you will code the diabetes first, but in this case, the patient was getting diabetic ketoacidosis due to the fact that the insulin pump was malfunctioning and wasn't getting the insulin to the patient. Therefore, you will have to code the insulin pump malfunction first, with the diabetes with ketoacodosis second. As for the E code, I don't think it is necessary to have an E code since all the information was leaning toward these two codes.
Lori Woods:
Thanks Carolyn we all seem to be in agreement now just the two codes & no E code. So nice to have this forum to have things clarified so next time I am faced with a similar question I will feel confident I chose the correct codes.
Alicia Scott:
Great job ladies. That is exactly how you walk through those questions. Just so you know if there was an E code that would apply and it was the initial encounter then you would use it. It doesn't matter that the story was described. It is for tracking purposes.
Carolyn Health:
Alicia, thanks for the compliment. We learn from the best.
Alicia Scott:
Just a quick note about ICD-10 regarding E codes. We will not have E codes per say but there will be codes like E Codes. On top of that you will carry the reason for the accident through each encounter unlike it is now where you only code it in the initial encounter. Pretty cool huh? This is going to be a good thing because the powers that be will see why the injury happened instead of having to walk through previous encounters to find out.
Think of ICD-10 as making you a better coder because you will have better tools/codes to work with.
Alicia Scott:
I like that last statement and think I will use it in a presentation!!!!!
Lori Woods:
I agree Alicia I have learned some of both ICD's in my studies & agree 10 will be much better. I seem to feel more confident choosing codes because of the greater detail.
Ruth Sheets:
Alicia covered more background on Diabetic ketoacidosis in the April Q&A Webinar. You may view the replay of this video, as well as all the replays from the past, read the transcripts and answer sheets when you join the CCO Club. For more information about the CCO Club, click here. Here are some key points she discussed:
Diabetic Ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
996.57 - Mechanical complication; due to insulin pump
Select this code to report mechanical failure of an insulin pump, a device used by diabetics that injects insulin into the bloodstream and intervals to regulate blood sugar levels.
250.10 - Diabetes with ketoacidosis; type II or unspecified type, not stated as uncontrolled
Use additional code, if applicable, for associated long-term (current) insulin use V58.67
CarolB: What is the proper code for a diabetic with ketoacidosis due to a malfunction of an insulin pump, the pump failed to deliver insulin causing ketoacidosis?
Answer Thread:
Luna:
Looking at the ICD-9-CM guidelines (Section 1.C.3.6.a.), my understanding is that you would code 996.57, Mechanical complication due to insulin pump first, followed by 250.1* Diabetes with ketoacidosis (without mention of coma).
(*appropriate 5th digit for type of DM)
Guideline reads:
" Underdose of insulin due to insulin pump failure: An underdose of insulin due to an insulin pump failure should be assigned 996.57, Mechanical complication due to insulin pump, as the principle or first listed code, followed by the appropriate diabetes mellitus code based on documentation."
I am not sure an E code is necessary as the sequencing of the two other codes already completes the story. Patient's insulin pump failed resulting in ketoacidosis. An E code is usually used in the case of poisoning or an overdose. But this does not fall under overdose. This is an underdose if the "pump failed to deliver insulin, causing ketoacidosis.
Of interest too, is if a pump delivered too much insulin, resulting in a complication then the guidelines (Section 1.C.3.6.b) instruct:
"Overdose of insulin due to insulin pump failure: The principal or first listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be 996. 57 Mechanical complication due to insulin pump, followed by 962.3 Poisoning by insulins and antidiabetic agents, and the appropriate diabetes mellitus code based on documentation."
So, as far as it looks, neither incident requires an E code.
I'm an early student and may be in error. I've been Googling to find out if an E-code is required and if I find something more helpful or that confirms one way or other I'll be sure to share.
CarolB: But would't there be an ecode for the malfunctioning insulin pump as a device causing a problem?
Lori Woods: E932.3 insulin & anti-diabetic agents might be what you are looking for.
Luna:
That is interesting.
My thought though was that the E932.3 code is essentially saying patient was getting the "correct drug properly administered in therapeutic dosage" (quoted from the category guidelines), but had an adverse reaction of effect to it.
However, the patient actually was not receiving the correct dosage and that is what caused the ketoacidosis. Ketoacidosis was not a reaction the patient had to the insulin, it is the result of not getting the insulin. Thus the code 996.57, Mechanical complication due to insulin pump tells there was a problem with the pump not administering the med, and code 250.1* Diabetes with ketoacidosis tells what it resulted in.
That was the thing that stumped me about using this E code. I think this E code is saying the insulin caused an adverse effect.
Lori Woods: Luna I thought since you already addressed the device malfunction they were asking for any E code regarding the insulin taken properly but ending up being an overdose because of it. I misunderstood I guess.
Luna:
Lori, I think she is looking for an E code for the under dosage due to the failed mechanics, but I don't think there is one. There are E codes for adverse effects in therapeutic use of drugs, and there are poison codes but I am stumped at finding anything related to a condition that developed because of not receiving a drug or enough of a drug. I don't think this scenario gets an E code.
I also think the sequencing is the diabetic code (250.1*) followed by the failed mechanics code 996.57 since it states "Due to". So it pretty much tells the complete story that patient is "diabetic with ketoacidosis" "due to failed insulin pump".
Lori Woods:
Yes, that was the only thing I could find & I wouldn't have assigned it either. I would have coded it the same as you.
Luna:
And my bad, but I think I'm wrong on the sequencing in my last comment. The guidelines state to code the failed pump as first listed followed by the appropriate diabetic code. (If I think too long I get all twisted around. LOL)
CarolB:
Ok, this is what I am looking for the Insulin pump malfunction so I want an ecode for device malfunction much like when a pacemaker malfunctions the codes are 996.01 with ecode e878.1, I just am not sure what type of device this Insulin pump would go under as far as ecodes.
Lori Woods:
Lol I have to really watch what I say too that one word you don't include in your coding or don't say when talking about it. That's why talking about it hopefully my detail orientation will improve meaning I would code it as the insulin pump failure & of course the diabetic due to Ketoacidosis. But then when you talk about other codes with others you can see different sides on why or why not you would or wouldn't include other things. I believe the 250.1 covers the inadequate drug because it basically said the failure to deliver the insulin caused the ketoacidosis ( I also have to watch my spelling wrong spelling can change stuff too ). The original statement led me to believe they knew the other codes but was curious about possible E codes. And then I misread overdose not underdose when I suggested the E code. I was just thinking if they had received the proper amount of insulin intended which would have been therapeutic. You see how my mind wanders & then I question my choices lol.
Lori Woods:
I believe Luna is correct only code 996.57 would be used to cover this.
Carolyn Heath:
The codes are as follows and in order according to the guidelines:
996.57 - malfunction of insulin pump (to find the code: complications, insulin pump)
250.10 - diabetes with ketoacidosis (to find the code: diabetes, ketoacidosis)
Normally, you will code the diabetes first, but in this case, the patient was getting diabetic ketoacidosis due to the fact that the insulin pump was malfunctioning and wasn't getting the insulin to the patient. Therefore, you will have to code the insulin pump malfunction first, with the diabetes with ketoacodosis second. As for the E code, I don't think it is necessary to have an E code since all the information was leaning toward these two codes.
Lori Woods:
Thanks Carolyn we all seem to be in agreement now just the two codes & no E code. So nice to have this forum to have things clarified so next time I am faced with a similar question I will feel confident I chose the correct codes.
Alicia Scott:
Great job ladies. That is exactly how you walk through those questions. Just so you know if there was an E code that would apply and it was the initial encounter then you would use it. It doesn't matter that the story was described. It is for tracking purposes.
Carolyn Health:
Alicia, thanks for the compliment. We learn from the best.
Alicia Scott:
Just a quick note about ICD-10 regarding E codes. We will not have E codes per say but there will be codes like E Codes. On top of that you will carry the reason for the accident through each encounter unlike it is now where you only code it in the initial encounter. Pretty cool huh? This is going to be a good thing because the powers that be will see why the injury happened instead of having to walk through previous encounters to find out.
Think of ICD-10 as making you a better coder because you will have better tools/codes to work with.
Alicia Scott:
I like that last statement and think I will use it in a presentation!!!!!
Lori Woods:
I agree Alicia I have learned some of both ICD's in my studies & agree 10 will be much better. I seem to feel more confident choosing codes because of the greater detail.
Ruth Sheets:
Alicia covered more background on Diabetic ketoacidosis in the April Q&A Webinar. You may view the replay of this video, as well as all the replays from the past, read the transcripts and answer sheets when you join the CCO Club. For more information about the CCO Club, click here. Here are some key points she discussed:
Diabetic Ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones.
996.57 - Mechanical complication; due to insulin pump
Select this code to report mechanical failure of an insulin pump, a device used by diabetics that injects insulin into the bloodstream and intervals to regulate blood sugar levels.
250.10 - Diabetes with ketoacidosis; type II or unspecified type, not stated as uncontrolled
Use additional code, if applicable, for associated long-term (current) insulin use V58.67
