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Diagnosis coding guideline for diabetes complication nec codes

  1. Default Diagnosis coding guideline for diabetes complication nec codes
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    I'm hoping someone can clarify how to appropriately assign diabetes complication nec codes. I've reviewed the chapter guidelines, "with" guidelines, and "nec" guidelines and still don't feel clear. I attended an ICD10 update where the presenter stated that if an ICD10 code exists for the complication then the nec complication code is not to be used based on "nec" guidelines. The example she gave was diabetes with cellulitis. Most of us in the class thought we should report E11.628 and the appropriate cellulitis code. But the presenter said that since cellulitis is classified elsewhere in the ICD10 manual it's inappropriate to use E11.628 since it's an "nec" code. She sited a Coding Clinic article where this coding scenario was addressed. If that is the case, when would you ever report a diabetes nec code? Can anyone shed some light on this for me? Thanks in advance.

  2. #2
    Columbia, MO
    first you start with the index.. look for diabetes then type 1 or type 2.. then under the indented term with look for the condition. cellulitis is not listed but other skin conditions is listed and it leads you to the E10 or E11.628 code. when the index leads you that codes then you will use it. if the provider documents any condition as being due to the diabetes and there is not specific code for that condition in the diabetes realm then you would use the NEC choice. I am afraid the instructor was slightly confused.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    If the provider documents "diabetes with cellulitis" is that saying cellulitis is a complication of or due to diabetes? To use a complication NEC code, wouldn't it have to be specified as a complication and not merely an association? If the classification accepted that association, I wonder why they used the term complication and not condition in the Index?

    Coding Clinic 2018 3rd Quarter gives an example of a heel pressure ulcer associated with diabetic neuropathy. Even though the provider links pressure ulcer to diabetic neuropathy with the use of "associated with", the Coding Clinic did not advise assigning the diabetic foot ulcer or any other diabetic complication code for that linkage.

    I do wish the Coding Clinic would clarify these issues once and for all and give more examples. I have many scenarios that I wish I could ask. Little trickles of advice come out that just seems to muddle the interpretations further.

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