Wiki Diabetes with PVD

[warrenfamily103@gmail.com]

I'm hoping to gain some insight on coding for Diabetes with PVD. From working in the field, I've always been told that if a patient has Diabetic PVD, E11.51 not to submit the code for PVD alone, I73.9 because the Diabetic code covers it. Looking at the CMS mappings for E11.51, it shows HCC categories 18 and 108, showing that it is covering both as well. The confusion comes in when using the code book. when I look up the codes in the code book, I don't see an excludes note for either one stating they cannot be coded together. The only excludes 1 note that I see is for code I73.8_, other specified peripheral vascular diseases.....I appreciate any input on this, I want to be able to explain this to new coders if necessary.

 

[thomas7331]

In the alphabetic index, PVD (disease > vascular > peripheral) directs to I73.9 but has a subheading below for 'in diabetes mellitus' with an instruction to 'see E08-E13 with .51' instead. All of the codes in that category are combination codes which capture both the diabetes and the complication so it would be redundant (and incorrect coding) to add an additional code for unspecified PVD. Unlike the diabetic CKD codes or the diabetic skin ulcer codes, which have a 'Use additional code to identify....' note to instruct you to capture information that is not contained in the combination code (i.e. the stage of the CKD or the site and severity of the ulcer), there is no instructional note to use an additional code under the diabetic peripheral angiopathy codes.

You can also find support for this in the guidelines for the use of combination codes in Section I. B. 9 where it states: "Assign only the combination code when that code fully identifies the diagnostic conditions involved or when the Alphabetic Index so directs. Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code."