Wiki E/M Course Answer Issue Incorrect against Rule Re DM and Onychomycosis

[orawanjames-thomas@hotmail.com]

I just taken a Mod 8 Test / Qstn No. 1 of the Evaluation and Management Course. DX is: Onychomycosis and DM, I selected Answer C, however the online test is only accepting Answer A to be the correct answer.
However this goes against it's Reasoning which states:

* There was no mention of diabetic neuropathy or ulcer
* There was no documentation that the onychomycosis is a diabetic complication
* Pt. was seen for foot check, and the onychomycosis was found during this check
* Resulting this to be coded as 1st Dx: Oychomycosis B35.1 and 2nd DX: DM E11.9

Please correct this issue or explain why the system is accepting Answer A rather than Answer C. Thank you for your help.

ojt

 

[moeslilmom]

Answer A. is correct. The reasoning behind this can be found in the 2017 ICD-10-CM Guidelines for Coding and Reporting FY 2017 in Section IV.G. ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit. This code section is the coding guidelines used for outpatient services, which includes providers in provider-based office visits. This guideline states "List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for the encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describes an coexisting conditions".

Therefore, E11.9 would be the primary (first-listed) diagnosis since the reason for the patient's visit is an annual foot check due to her diabetes.