ICD - Classifying Diabetes and What it Means

I had my quarterly endo appointment last week and again I noticed that she had coded my chart and my test orders with the ICD diagnostic code 250.01 (type 1 diabetes, controlled). That code is selected from a standard used for consistly classifying diagnoses and is called the International Classification of Diseases (ICD).

The key classifications are:

250.00 type II or unspecified type, not stated as uncontrolled
Fifth-digit 0 is for use for type II patients, even if the patient requires insulin
250.01 type I [juvenile type], not stated as uncontrolled
250.02 type II or unspecified type, uncontrolled
Fifth-digit 2 is for use for type II patients, even if the patient requires insulin
250.03 type I [juvenile type], uncontrolled

In the past, my doctors have always coded me as 250.00, with an occaisonal 250.02 to emphasize how serious my condition is. In general, I think doctors only code you as uncontrolled if you have an A1c > 7%.

But for the second time in a row, my doctor has coded me as 250.01. I've always been diagnosed as T2. I've not made a big deal about my typing since I started insulin. My endo has basically helped me reach my target goals so it hasn't been an issue since starting insulin. But I don't know whether this matters. Has anyone else made observations about how their doctors classify their diagnosis? Since these codes seem mostly to be used for insurance and medicare/medicaid reimbursement purposes, has it made a difference in coverage? Has anyone been denied coverage for things because of their reimbursement coding?

I figure I should probably just go through my diagnosis again with my endo. If in the future I consider a pump, it may make a difference. But I doubt my insurance company would just accept some little number given on a form.

Sorry bsc,

My code has always been T1.

Maybe changing your code will make it easier to get insulin and/or more test strips?

My docs vacillate between writing it down as 250.00 and 250.01 depending on their mood and the phase of the moon :-). I'm T1 for 31 years now but I don't look like a "juvenile diabetic" anymore.

And in between juvenile diabetes and today, for a long long time 250.01 meant "insulin dependent diabetes", and that does include you, right?

250.01 might make for less hassle in getting insulin and plenty of test strips through insurance.

For a while I think the catch phrases were IDDM and NIDDM but I don't see those used as much as 10 or 15 years ago.

I've never noticed what code they put on my paperwork but I will look next time. If anything, I would think the Type 1 designation might make it easier for coverage related to frequency and type of tests run, test strips, pump and cgm. Since you're on insulin anyway, I don't see a downside to being labeled Type 1.

My husband and I were looking into some supplemental type insurance and I wasn't sure if I would be considered "uninsurable" or not. When I asked about coverage for PWD, I was told it depends on what type of medication you take. When I asked about those who take insulin, I was told you would not be eligible for coverage.

That is interesting. You've also had a bit of slop between being coded as T1 and T2. The terms IDDM and NIDDM were removed from the ICD in the 2004 version, but it takes quite a while for terms to fall out of use. And the current classification of a type 2 on insulin should be 250.00.

I've never encountered a diagnostic code on a standard prescription. And I've never gotten any resistance from insurance covering any of my insulin, strips etc. When I've gone for external tests tho the diagnostic code has been written on the order form. I've also seen it used internally in my health records.

Yeah, I'm in the same boat as you. I think it has to do with the old classification system that used to designate these as IDDM and NIDDM. As far as I know, I've always been classified as T1 or IDDM.

Personally, I think the IDDM/NIDDM is a better classification because it better distinguishes the type of care you need. If you're dependent on insulin, regardless of whether you're T1 or T2, your needs are kinda the same, right?

Don't get too attached to any words or numbers used to classify diabetes. I guarantee you they will change several more times in your lifetime as the understanding changes and improves.

I think to a large extent that the wordings we use today are often true but not useful. I think the term IDDM is going to be more useful to you, than Type 2.

our doctor frequently gets this mixed up because my husband is type2 and I'm type1 - but I just looked at the lab requests he gave us this week and he got it right. 250.00 for hubby and 250.01 for me.

I think your words are very true. After I was diagnosed I pondered long and hard about exactly what was wrong with me and why I got this dreadful condition. Today, I hope that I have come to terms with things and all that really matters is that I am able to effective treat me condition. Although my specific diagnosis has not affected me yet, these labels may make a huge difference the future (such as qualifying for a pump).