Archive for November 17th, 2010

November 17, 2010

Gangrene and diabetes are a pair, but not necessarily a commitment

My recent diabetes posting has generated a few questions:
Question: Even though diabetes may be the number one cause of a problem or is a major cause of a problem, the only manifestations that can be assumed are gangrene and osteomyelitis. Does that mean that as long as we code DM with circulatory manifestations, the gangrene doesn’t need any other codes?

Question: There used to be an assumed relationship between DM and gangrene. Has that changed?

Lisa says: Gangrene and diabetes are always a fun pair to code! In answer to these questions:

You still need to code the osteomyelitis or the gangrene with your diabetes code. So diabetic gangrene is 250.7x, 785.4. The medical assumption does not mean you skip the manifestation code.

What I meant by “number one cause of a problem or is a major cause of a problem” is that a lot of coders will assume relationships between diabetes and other potential manifestations such as CKD. Just because the patient has diabetes and it is a major cause of CKD does NOT mean that the CKD can be assumed to be diabetic. Besides gangrene and osteomyelitis, other potential manifestations need physician confirmation.

There is an assumed relationship of gangrene and diabetes, that has not changed. What I was trying to explain, and I hope I do a better job of it here, is that while gangrene is an assumed manifestation of diabetes, it does NOT follow that having gangrene means that you have diabetes. Gangrene can be a stand-alone problem, so make sure the patient has diabetic gangrene.
November 17, 2010

Amputation stump questions answered!

There is so much confusion on this kind of coding. I’ve written about it on my Musings of a Code-a-Holic page.