Wiki Diabetic ulcer with nephropathy

[Ruth A. Robillard]

I need help with interpretation. If a patient has a diabetic ulcer and also has neuropathy does that ulcer automatically become a neuropathic ulcer? We have been having discussions about this code and can't seem to come to an agreement. I feel that the doctor has to specify that the ulcer is due to the neuropathy and others feel that the neuropathy takes precedence. Can anyone help?

 

[sewncode]

I would code the diabetic ulcer ( say it is a foot) like this:
250.80
707.14 and then use 356.9 because we cannot assume that the cause of the neuropathy is DM. Unless it is stated that way.

If it is I would use these codes in sequence:
250.80
707.14
250.60
357.2

 

[mastovichta@upmc.edu]

diabetic neuropathy

A direct question regarding diabetic neuropathy documented by physician. I realize the codes used would be 250.60, 357.2. But, If there is nothing stated in the entire note about problems with legs, feet, nerves, lower extremity, etc. how can I just post the dx listed as 250.60 & 357.2. Shouldn't documentation support the neuropathy part of diabetic neuropathy?

 

[mitchellde]

A direct question regarding diabetic neuropathy documented by physician. I realize the codes used would be 250.60, 357.2. But, If there is nothing stated in the entire note about problems with legs, feet, nerves, lower extremity, etc. how can I just post the dx listed as 250.60 & 357.2. Shouldn't documentation support the neuropathy part of diabetic neuropathy?

You are absolutely correct. You are a coder not a doctor and a diagnosis cannot be presumed or assumed. You can code the diabetic ulcer because it is stated just not the diabetic nephropathy as it is not stated.

 

[mastovichta@upmc.edu]

Is there a coding clinic or specific guideline I can use to back this up?

 

[mitchellde]

You cannot assume a diagnosis is a related issue. Just because the patient has diabetes and neuropathy does not automatically make it diabetic neuropathy. The best I can tell you is to read the coding guidelines. The guidelines specify in those few instances when a relationship is to be presumed such as HTN and chronic kidney disease. Sepsis with no documented organism the infection is presumed to be septicemia unspecified.