Complex disorder of carbohydrate, fat, and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the cells of the pancreas or resistance to insulin. There are two types as shown in Table D-1 .

Program that educates patients in taking care of themselves because they have diabetes mellitus. It includes education about treatment, diet, and exercise.

Purchased or rented ambulatory items such as glucose meters and insulin infusion pumps, prescribed by a health care provider for use in managing a patient’s diabetes, as covered by the Medicare program.

1. Identification of a disease, syndrome, or condition by scientific evaluation of history, physical signs, symptoms, tests, and procedures. Diagnosis includes the technical description of the disease or condition and its cause, as well as the proper diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code book. 2. In Medicare fraud, misrepresenting the diagnosis for the patient to justify the service provided or equipment furnished.

Patient classification system that categorizes patients who are medically related with respect to principal diagnosis, presence of a surgical procedure, age, presence or absence of significant complications, treatment, and who are statistically similar in length of hospital stay. Medicare hospital insurance payments are based on fixed dollar amounts for a principal diagnosis as listed in DRGs regardless of the amount of charges accrued. See all patient diagnosis-related group (APDRG or AP-DRG) and inpatient prospective payment system (IPPS) .

Medical service performed such as biopsy, thyroid function test, or radiographic procedure to establish the cause of the patient’s complaints and symptoms.