Diagnosis issue

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Our radiologists do a lot of duplex scans for the lower extremities. The preoperative diagnosis given is bilateral lower extremity arterial insufficiency and right forefoot ischemia with tissue loss and nonhealing ulceration to the plantar surface and PAD. Findings do support the preoperative diagnosis above but I'm also given the patient has type 2 diabetes mellitus embedded in the paperwork.

If I wasn't given the patient had diabetes I would have coded it L97.411 and I73.9. My question on the above is do I use E11.621 now that I know the patient has diabetes or does the physician have to state diabetic foot ulcer?????????????

Thanks in advance,
 

LuckyLily

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The doctor has to state that the ulcer is caused by/due to the Diabetes which you would use E11.621. If it states that he had diabetes and does not relate the two issues together then code the correct diabetes code such as e11.9
 

mitchellde

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ICD-10 CM assumes the relationship exists. As long as both diabetes and the ulcer is documented in the same note the coder is to code this as an automatic diabetic condition. This has been clarified in the 2017 guidelines.
"With”
The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related.
If you look in the alpha section the key word diabetes has immediately following it the word "with". Then sequenced to Nader that are all the complications, and ther you will find foot ulcer as well as skin ulcer.
 
Last edited:

cgonthier

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Ulcer toe amputation

Hi
Procedure: Debridement, skin
Location: Ulcer, s/p left 2nd toe amputation.

how would you code this scenario out?
I would use T87.54. but I am not sure about the diabetes E11.621 or the L97.521.
thank you,
 
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