Podiatry Coding & Billing Alert

Question: A patient visited our clinic for a checkup for some ulcers on her right ankle. She had the toes on her right foot amputated six months ago due to gangrene. She has type II diabetes, peripheral vascular disease (PVD) and malignant hypertension. How should I code her condition?

Nevada Subscriber

Answer: For your patient, code:

• 250.70 -- Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled
• 443.81 -- Peripheral angiopathy in diseases classified elsewhere
• V49.73 -- Foot amputation status
• 401.0 -- Malignant essential hypertension.

Report 250.70 for diabetes with peripheral circulatory disorders, then list the manifestation code for PVD. In this case, it's 443.81. Use V49.73 to identify the specific amputation site. You should use the V49.6x and V49.7x codes only to report acquired amputation status due to trauma or surgical amputation due to disease.

For the hypertension, list 401.0 for this patient. Don't list a code for gangrene because it's no longer present. The PVD, however, is likely to continue to be a problem, so listing 443.81 is appropriate.

Note: ICD-9 assumes the gangrene is a consequence of a diabetic peripheral vascular circulatory disorder. This is usually true when the gangrene is of the lower extremity. If there is no other stated cause, gangrene is considered a manifestation of diabetes.