Diabetic Wound Care Diagnoses

Reenie98

Contributor
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Columbus, Ohi
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When billing for Diabetic Wound Care; our LMRP suggests the patient need to have co morbidities to support the billing of the Wound Care.

Our physician is listing the following in his impression
Diabetes Mellitus
Ankle Ulcer
Peripheral Neuropathy
Venous Insufficiency

He debrides the wound
We are coding 11042
Dx: 250.80, 707.13, 337.1, 459.81

Upon audit; we were told we can only code what the physician treated; and he is not treating anything but the ulcer in the debridement; so we should only code the Ankle Ulcer.

We feel we can support the co morbidities with the HPI and Exam; and ICD 9 states to code comorbidities that affect patient care. (HPI states patient is referred for delayed healing due to DM, peripheral neuropathy; and Venous Insufficiency; and the exam indicates the presence of all 3; and all 4 dx are in the impression). The auditor is stating he must state they are causing the delay of healing in the impression; and if he doesn't we cannot code them?

This seemed odd to me as my training was you could use the whole note to support your billing? I thought I would check on how other coders are doing this before we respond to the auditor; or ask our physicians to document differently.
Thanks
 

mitchellde

True Blue
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13,463
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Columbia, MO
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Does the provider indicate that the wound is a diabetic complication? If so the 250.80 is the appropriate first listed code as you are treating a diabetic complication. However the provider must link the the problem as being caused by/ due to the diabetes.
 

Porter_kd

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I recently took the "Common Coding E/M Conundrums" class. They stated that per guidelines, the best place to find the problems addressed during the encounter is mentioned in the assessment and plan portion of the note. I do follow this advise on a day by day basis. I skimmed through the E&M service guide that CMS puts out and it does state that "the number of possible diagnoses and/or number of management options that must be considered is based on: 1)the number and types of problems addressed during the encounter, 2) the complexity of establishing a diagnosis; and 3) the management decisions that are made by the physician. Make sure you have the ICD-9 guidelines and read the E&M Services Guide through CMS and bring that to the table as well.
 

Reenie98

Contributor
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Columbus, Ohi
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That is awesome advice. Thank you so very much for taking the time to assist me. That sounds like a very informative class!
 
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