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Diabetic ulcer with nephropathy

  1. Default Diabetic ulcer with nephropathy
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    I need help with interpretation. If a patient has a diabetic ulcer and also has neuropathy does that ulcer automatically become a neuropathic ulcer? We have been having discussions about this code and can't seem to come to an agreement. I feel that the doctor has to specify that the ulcer is due to the neuropathy and others feel that the neuropathy takes precedence. Can anyone help?

  2. Default
    I would code the diabetic ulcer ( say it is a foot) like this:
    250.80
    707.14 and then use 356.9 because we cannot assume that the cause of the neuropathy is DM. Unless it is stated that way.

    If it is I would use these codes in sequence:
    250.80
    707.14
    250.60
    357.2

  3. Default diabetic neuropathy
    A direct question regarding diabetic neuropathy documented by physician. I realize the codes used would be 250.60, 357.2. But, If there is nothing stated in the entire note about problems with legs, feet, nerves, lower extremity, etc. how can I just post the dx listed as 250.60 & 357.2. Shouldn't documentation support the neuropathy part of diabetic neuropathy?

  4. #4
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    Quote Originally Posted by tmastovich View Post
    A direct question regarding diabetic neuropathy documented by physician. I realize the codes used would be 250.60, 357.2. But, If there is nothing stated in the entire note about problems with legs, feet, nerves, lower extremity, etc. how can I just post the dx listed as 250.60 & 357.2. Shouldn't documentation support the neuropathy part of diabetic neuropathy?
    You are absolutely correct. You are a coder not a doctor and a diagnosis cannot be presumed or assumed. You can code the diabetic ulcer because it is stated just not the diabetic nephropathy as it is not stated.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Is there a coding clinic or specific guideline I can use to back this up?

  6. #6
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    You cannot assume a diagnosis is a related issue. Just because the patient has diabetes and neuropathy does not automatically make it diabetic neuropathy. The best I can tell you is to read the coding guidelines. The guidelines specify in those few instances when a relationship is to be presumed such as HTN and chronic kidney disease. Sepsis with no documented organism the infection is presumed to be septicemia unspecified.

    Debra A. Mitchell, MSPH, CPC-H

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