# How would you code this..... Diabetic Ulcer Debridement



## lopezk89

I am having some issuse with codeing this I have looked at evrything in the case studie and can not figure it out I get it wrong every time....I need the CPT and ICD 9 Codes for this .Debridement of 16 sq. cm. subcutaneous tissue and muscle due to diabetic foot ulcer. I have 11042 and diagnosis of 249.80 and 707.15 Can some one help please


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## ollielooya

Hi, just wondering if perhaps your choice of CPT code might be reconsidered, since your note states it involves *BOTH* tissue and muscle and the 11042 denotes subcutaneous tissue.  Dig a little deeper into the code classification. Hopefully, others will comment and set us both straight?


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## espressoguy

If it were me, I would probably code 11043 since muscle is mentioned with a dx of 707.14 primary and 250.00 secondary.


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## Cyndi113

Use 250.8x as the DM code. Read both your ulcer and 250.8x additional code instructions.


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## ollielooya

*After re-reading the initial post*

Glad there have been some additional responses.  I noticed that the poster had listed 249.80 as the diabetes code.  Again, you might want to re-examine your choices as thie is the category for *secondary* diabetes mellitus.  Just a thought...


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## mitchellde

lopezk89 said:


> I am having some issuse with codeing this I have looked at evrything in the case studie and can not figure it out I get it wrong every time....I need the CPT and ICD 9 Codes for this .Debridement of 16 sq. cm. subcutaneous tissue and muscle due to diabetic foot ulcer. I have 11042 and diagnosis of 249.80 and 707.15 Can some one help please[/QUO
> 249.x is for secondary diabetes.  From ehat you have provided there is nothing to indicate secondary diabetes.  Therefore you must code the 250.80
> As the first listed code with the 707.1x secondary.
> To the poster suggesting the 707.15 first with 250.00 secondary:
> When documentation ststes the ulcer is diabetic or due to or eith the disbetes then the diabetes codeust be first listed wit a 4 th digit other than 0 for the complication.  I would need a procedure note for the CPT code.


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## lopezk89

*Thank You Everyone*

I have Figured it out with your help ... That little bit info was what was given to me to code from that's why I think I was having some much trouble and the 11042 and the 707.15 and 250.80 where the codes that I needed thank you again ....


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## solocoder

Medicare, however, wants the DM with manifestation codes listed the other way round.  250.80 first, followed by 707.1X.


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## mitchellde

That is not just Medicare.  The diabetes with manifestation code is always first listed according to the coding guidelines.


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## isabel.bickle@yahoo.com

*Medicaid Analyst*

The diabetes is coded first.  The ICD-9 index under "ulcer, diabetes, foot" indicates to use 250.8x and "ulcer, foot" to use 707.15.  Since the submitted information does not indicate the type of diabetes or if it's controlled or not, use 250.80 (type II or unspecified, not stated as uncontrolled) as the primary diagnosis.  If the chart note indicates a specific part of the foot, use the most appropriate code in the 707.1x series. 

This is what I would code: 11043 with 250.80, 707.15
________________________________  
Isabel Bickle, RN, BSN, CPC
Medical Policy Analyst 
Division of Medical Assistance Programs
Salem OR


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## maycricket

Actually it will depend on your MAC as to whether your code selection is ordered per CPT guidelines.  WPS wants the ULCER first as that is what is being debrided, with the DM manifestation second.  Make sure you check for LCD's specific to wound care within your MAC jurisdiction.  For WPS, I would code diagnoses as follows for a diabetic foot ulcer:  707.15, 250.80.


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## mitchellde

maycricket said:


> Actually it will depend on your MAC as to whether your code selection is ordered per CPT guidelines.  WPS wants the ULCER first as that is what is being debrided, with the DM manifestation second.  Make sure you check for LCD's specific to wound care within your MAC jurisdiction.  For WPS, I would code diagnoses as follows for a diabetic foot ulcer:  707.15, 250.80.


The order of the diagnosis codes does not depend upon MAC preference, and it is not a CPT guideline.  This is an ICD-9 guideline which are mandated to be followed per HIPAA.  Read the guidelines in the front of your ICD-9 book 3 rd paragraph page 1.  Then go to the diabetes section.  There it states that if the provider links the manifestation to the diabetes  then you are to code the diabetes first listed.  There is no carrier rule that can over ride this guideline.


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