Diagnosis Codes

I just had my three month appointment at my doctor's (who knows little about my Type 1, but just writes prescriptions for me, but I thought does know I'm Type 1. So she wrote me a lab slip, and when I looked at it the code was 250.00. Not knowing the codes, but, for some reason, feeling the need to check, I looked it up and unless I'm mistaken, 250.00 is Type 2 and 250.01 is Type 1. Is this a mistake, and has anyone else had this problem before?

I know it's just a lab slip, but if that's how she has me listed it could affect things like my Medicare and pump coverage!

I had something similar happen. My doctor coded my chart properly, but when the billing department submitted the bill to my insurer, they marked it 250.00. I exchanged emails with my endo's staff and they spoke to the billing department to have it resubmitted with the proper code. I was concerned about having anything in my insurance record that said T2 because I don't want to have to fight even harder for resources.

Exactly, Shadow Dragon! This really bothers me! I mean some of it is left-over resentment from being originally misdiagnosed due to age. I identify strongly with being Type 1! But some of it is very concrete anxiety that I will have problems, for example when I go to get a new pump. I'm sure it's just an error, but it bugs me! I will go back to the clinic on Monday; I wish I could do it sooner!

Talk to your doctor, that's really the best option. Mine always has said 250.01 on everything and I'd be paranoid if it said anything other than 250.01, too.

Don't read too much into the diagnostic coding. The codes sometimes referred to as, ICD code, are used by payers (like Medicare and insurance) to determine whether the ordered test or treatment is appropriate. For more than a year every lab order and prescription from my endo has coded me as 250.01 (Type 1) despite me being T2. I suspect that my endo does this so that I won't have any trouble with my insulin or if I seek a pump. In the end, I would not worry about it. While I've heard about prescriptions and treatments being rejected because of incorrect ICD codes, the solution is always to simply return it to the doctor and get the ICD code corrected. I've never heard of Medicare or any insurance looking back at patient history and questioning anyone's diagnosis.

ps. If your doctor gives you a pump or CGM prescription and codes it 250.00, that is a problem. But most doctors are careful enough and realize that they will have to correct the code and resubmit so they mark it properly. But for an A1c test? Who cares.

The entire medical record needs to be correct, even a lab slip. It's going to matter even more when the ICD-10-CM/PCS is implemented and compliance requirements come to play. We should all be looking at all of our codes (the dx and procedure ones as well)! Get your code corrected, Zoe. And way to go for catching that.

Brian....There is a whole misconception that Type 2's won't be provided pumps. A lot of us have them despite the 250.0. If you have a need that the doc documents it will get through regardless of the type. The issue comes down to if the doctor documented the need not the ICD.

I agree, Karen. And Brian,no offense, but it's all well and good for a Type 2 not to be concerned about being mis-coded as a Type 1, since Type 1's are more readily granted things like sufficient test strips, pumps and cgm's! For a Type 1 to be miscoded Type 2 is concerning. It also is a whole other ballgame when you are on Medicare since they are by nature very restricting of services. I agree that one lab slip is not important, but if it is wrong there, chances are it is wrong in other areas of my records.

Yep, it's the first thing on my list for Monday morning.

My insurance company treats type 1 and type 2 very differently in terms of who qualifies for a pump. I'm not saying a T2 can't get a pump but it is much much harder.

I don't disagree with this ideal but the issue is much much deeper. While you may walk out with a lab order that shows you the coding you have no visibility into the vast majority of your health record. You never see most of the communication between your providers and insurance. Look through you claims and explanations of benefits, you won't see anything about coding.

I don't disagree, but the big problem is that we as patients are denied ownership of our health records. We can't see them and we denied the access to correct them.

Well, my own EOB (explanation of benefits) clearly lists the codes on all of my papers as well as the dates, the amounts...etc.

We can get access and even request copies from our own health records. HIPPA gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule.

Correcting information is also a right. If you think the information in your medical or billing record is incorrect, you can request that the health care provider or health plan amend the record. The health care provider or health plan must respond to your request. If it created the information, it must amend the information if it is inaccurate or incomplete. If the provider or plan does not agree to your request, you have the right to submit a statement of disagreement that the provider or plan must add to your record.

@ Brian - If you are being denied access to correct a health record, or even review and get copies of anything you want from yours, then you should contact the HHS’ Office for Civil Rights who are there to protect these rights and rules.

I don't think we're supposed to be offended too much :-). 250.00 in addition to being T2, is also a "catch-all" that handles it when no specific type is specified.

Incidentally it's only been in the last 5 years or so that "juvenile type" was removed from the definition of 250.01.

I find them writing 250.00 and 250.01 about 50/50 for me. I have never presumed to correct the ICD. If I'm talking to them and they start assuming I don't need insulin or test strips, I will quickly correct them. And remind them that even though I now have grey hair (and less of it!), I was diagnosed with Juvenile Diabetes a third of a century ago and that insulin is not optional.

Like Karen, my EOBs show the diagnostic code. That's how I knew the bill had been submitted with the wrong code.

I was switched from T1 to T2 a couple of years ago at the “network” where my GP is at. He fixed it after like a year.

At least you didn't get marked "non-compliant" in your health record and lose your life insurance like I did.

How awful, Brian! Has it been reinstated?

I think these things just emphasize how important it is for us to stay on top of these things. I joke around on here about how I just want to have a doctor that "writes my prescriptions and otherwise doesn't bother me." (well I'm sort of joking!) But I think helping them enforce their own dictum of "First Do No Harm" is in our ballcourts as well!

In truth what happened was I experienced very serious side effects from statins. My doctor refused to believe me and recorded that I was "non compliant" because I refused to submit to statination. Later when I applied for life insurance and they reviewed my records the refused to insure me citing my "non compliance."

I no longer trust doctors and the healthcare system to do no harm. Instead I have learned to expect harm.

I think that makes it more and more important we each keep ourselves (and each other!) well informed and speak up either verbally or by switching care providers when we see something we question.

You are absolutely right....it could indeed affect coverage. I would give the doctor a heads up asap!!

Thanks, Linda, I plan on it! I'm practicing my moderated tone now for if she says something infuriating like "but at your age (or diagnosed as an adult) you are considered type 2" or "there really isn't any difference between the two, so why does it matter?" Yep, Brian, you aren't the only one with low expectations of doctors!