Physician and Mr. Jones
Page 12 of 16

dr Physician sees Mr. Jones whom he suspects is a type 2 diabetic. Mr. Jones’ Hemoglobin A1C was higher than normal but not yet high enough to be diagnosed as diabetic. This would place him in the category of pre-diabetic.  However, while this patient’s condition could be treated with diet and exercise the physician feels it is in the best interest of the patient to treat aggressively with insulin; thus he chooses a ICD-9 code that will ensure that the medication is covered by insurance. This code while paying for the medicine categorizes him into a higher insurance risk for the rest of his life.

Physician monitors the patient over a 6 month period and at that time he finds the patient's glucose level has increased. In talking with the patient he learns that the patient lost his job and has been unable to purchase new insurance because of his preexisting condition of diabetes. He has not been taking his insulin because he cannot afford it.

 

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