On a diagnostic audit of patient dx with syphilis we found that documentation review revealed the patient had Charcot Arthropathy, most likely due to diabetes, not syphilis (no labs or any indication of syphilis anywhere). The billing department at the provider's opffice indicated that their direction is that Charcot Arthropathy always bills the 713.5 and 0.94 codes together. Our stance is that this should be billed as Diabetes (249 or 250 code as appropriate) and 713.5, without the code for syphilis. Thoughts?
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Wiki Charcot Arthropathy
- Thread starter kksmom
- Start date
If syphilis is not mentioned then it cannot be coded to 094.0 per AHA coding clinic, 2012, 3rd issue. This directs the coder to use 349.9, Unspecified disorders of nervous system, and 713.5, Arthropathy associated with neurological disorders, for a diagnosis of Charcot?s arthropathy. It direct's the coder to index this diagnosis as follows: Arthropathy-->neurogenic, neuropathic (Charcot's)(tabetic) --> nonsyphilitic NEC 349.9 [713.5]
If a direct link is established with diabetes, then it would index and code to the appropriate diabetes category, 249 or 250, with a 4th digit subcategory of 6 for the neurologic manifestation, and then 713.5 as the secondary code.
Just my 2 cents on a side note, I would not take "most likely due to" as appropriately establishing a direct link from an audit perspective.
If a direct link is established with diabetes, then it would index and code to the appropriate diabetes category, 249 or 250, with a 4th digit subcategory of 6 for the neurologic manifestation, and then 713.5 as the secondary code.
Just my 2 cents on a side note, I would not take "most likely due to" as appropriately establishing a direct link from an audit perspective.
mitchellde
True Blue
I see where they get that, in the alpha Charcot arthropathic defaults to the 094.0 with the 713.5. I would not code a most likely due to statement either. However I feel the provider should have been queried regarding the diagnosis since the coder is led to the 094.0 . However in the tabular section if you look under 713.5 it states to code first, l
Then it has
Not otherwise specified 094.0
So in actuality they had coded it correctly, I personally would have discussed with the provider first. The problem is you do not know if it is nonsyphilitic or not so I think the NOS prevails.
Then it has
Not otherwise specified 094.0
So in actuality they had coded it correctly, I personally would have discussed with the provider first. The problem is you do not know if it is nonsyphilitic or not so I think the NOS prevails.