Wiki Diabetes and Pressure Ulcer Guidance

[Distheone]

I am very confused with this guidance from the Coding Clinic, Third Quarter 2018: "If a patient is diagnosed with a pressure ulcer associated with diabetic neuropathy and diabetic peripheral vascular disease, it is reportable as code I96, Gangrene not elsewhere classified, and code from L89, Pressure ulcer, rather than as a diabetic skin ulcer. Report additional codes to capture the peripheral angiopathy and neurological complications of diabetes. In this instance, do not associate the diabetes with the gangrene (eg, do not report code E11.51, Type 2 diabetes mellitus with peripheral angiopathy without gangrene."

Would someone please help me to interpret this? I am not understanding why I should automatically code the gangrene if it is documented as a diabetic pressure ulcer...

 

[thomas7331]

I'm not sure I'm looking at the same question as you are from this edition of Coding Clinic. I see a question which gives a diagnosis of a "Stage 3 necrotic decubitus ulcer...". Since the provider has documented the presence of necrosis, this codes to gangrene per the Alphabetic Index, and since the pressure ulcer codes in the L89 category carry the instruction to "code first any associated gangrene", then I96 should be reported as the primary code. Does that make sense or answer the question you have? I don't see that it says not to code E11.51 though - are you looking at a different question?

 

[Distheone]

I'm not sure I'm looking at the same question as you are from this edition of Coding Clinic. I see a question which gives a diagnosis of a "Stage 3 necrotic decubitus ulcer...". Since the provider has documented the presence of necrosis, this codes to gangrene per the Alphabetic Index, and since the pressure ulcer codes in the L89 category carry the instruction to "code first any associated gangrene", then I96 should be reported as the primary code. Does that make sense or answer the question you have? I don't see that it says not to code E11.51 though - are you looking at a different question?

This clears it up for me and assures me that I know how to code these diagnoses. I do not have access to the actual Coding Clinic, but I quoted this exactly as written as a "Coding Tip" noted on page 159 in the book, Risk Adjustment & Documentation and Coding by Sheri Poe Bernard. Thankfully because of my knowledge base I could not accept this as correct guidance. I only wish I had asked this question months ago as I have been laboring over this as I studied for my CRC (took my exam yesterday). Thank you for your response!