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Hybrid Induction
Home Health Coding: Double Diabetes Or Hybrid Diabetes
Diabetes coding question: What kind of supporting data would I need to report a Type 2 diabetes code for the phrase, "insulin dependent diabetes"? I've this note that only states "insulin dependent diabetes" as a diagnosis. There was no mention made whether it was controlled or uncontrolled, or Type 1 or 2. So I asked the physician whose response is, "The patient's neither type but in between." How should I go about coding this diagnosis?
Answer: There's a new type of diabetes called Type 3 or Type 1½. According to Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, Texas, the phenomenon is also called double diabetes" or "hybrid diabetes, and it is tougher to diagnose and significantly more difficult to treat.
Heard about Type 3? Read on…
The person has Type 1 diabetes treated with insulin but has insulin resistance too. According to a research, Alzheimer's may even be Type 3. A lot of the unexplained features of of Alzheimer's like cell death and tangles in the brain appear to be linked to abnormalities in insulin signaling. This shows that the disease is most probably a neuroendocrine disorder or another type of diabetes.
There is presently no specific code for Type 3. You need to code the diabetes as unspecified with a fifth digit of "0". Moreover, you should add the code V58.67 (Long-term [current] use of insulin) if the patient is expected to be on insulin long-term.
Tip: Make it a point to ask the physician when insulin dependent diabetes" is documented because the term is outdated, and its real meaning is juvenile type diabetes. With such a statement from the physician, you may think about asking whether the diabetes was inducted by another condition or event, like steroid induced diabetes as there's no Type 1 or Type 2 in steroid induced diabetes, now coded with a 249.x (Secondary diabetes mellitus) category code.
About the Author
Jan Mater-Cavagnero MA, HCS-D, specializes in diagnosis coding for home health agencies, as well as the wide variety of issues that impact the hospice industry. Jan is an editor-in-chief for Eli Healthcare, where she has written Home Health ICD-9 Alert for five years.
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