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Gangrene and diabetic foot ulcer

  1. #1
    Question Gangrene and diabetic foot ulcer
    Medical Coding Books
    Hi-
    i just took a refresher course on icd 10 on aapc and one of the practice to be coded examples states pt was seen for a diabetic right great toe ulcer with gangrene, necrosis to the bone. The "correct" answer is
    e11.621
    i96
    l97.514
    why is i96 on there when the book states i96 excludes gangrene in diabetes mellitus? If the book states a problem is excluded from a code why does it have to be coded?
    Thanks

  2. #2
    Location
    Columbia, MO
    Posts
    13,135
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    You are correct it is an exclude 1 exclusion and cannot be coded with the diabetes code. This will over ride the note at L97 to code first the I96. I would speak with whomever you took the class thru and point out that this is incorrect.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Thank you!

  4. Default Gangrene guidelenes
    Could you pls shed some light on how this is coded? Any idea about wet gangrene??

  5. Question Diabetic foot ulcer with gangrene code sequencing.
    Hi! On coding diabetic foot ulcer with gangrene, which code should be sequenced first?
    DM gangrene has higher DRG when coded but there's a confusing statement on the coding handbook for DM complications that foot ulcer code should be assigned first with additional code for the ulcer site and, if gangrene is present, it should be assigned as an additional code. On tabular, DM gangrene and DM foot ulcer have separate codes. This patient had BKA procedure for the condition stated.
    Thanks!

  6. #6
    Location
    Columbia, MO
    Posts
    13,135
    Default
    The only diabetes code that states with gangrene is for peripheral angiopathy with gangrene. If the patient has this condition and the diabetic foot ulcers, then code both conditions and you may use the peripheral angiopathy with gangrene first listed. However if that is not the diagnosis and it states only dues ethic foot ulcers with gangrene, then you code the with foot ulcers code and add the L97 code that applies which will probably be the one that indicates with necrosis of muscle or necrosis of bone.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    Quote Originally Posted by mitchellde View Post
    The only diabetes code that states with gangrene is for peripheral angiopathy with gangrene. If the patient has this condition and the diabetic foot ulcers, then code both conditions and you may use the peripheral angiopathy with gangrene first listed. However if that is not the diagnosis and it states only dues ethic foot ulcers with gangrene, then you code the with foot ulcers code and add the L97 code that applies which will probably be the one that indicates with necrosis of muscle or necrosis of bone.
    I do support the same, can't think of a better answer. I would first code E11.621, with L97.4_4

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