# Diabetic Ulcers



## mgord (Jan 15, 2009)

MD sees a pt with a diabetic foot ulcer and marks 250.70 and 707.15 on the encounter.
When I look up ulcer in ICD-9, the notes say to use 250.80 with the 707.1x. Is there ever an instance where the 250.70 would be correct? 


Thanks,
MB


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## Anna Weaver (Jan 16, 2009)

*250.70*

Yes, in ICD-9 2009 Physician, the 250.70 is listed with a description of:
Blood vessel damage or disease, usually in the feet, legs, or hands, as a complication of diabetes. 

It's entirely possible to have circulatory disease or symptoms with ulcer due to diabetes. The lack of good circulation also causes ulcers to delay healing.


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## mgord (Jan 16, 2009)

How will I know if I should use the .70 or .80 if all the documentation says is diabetic ulcer? When I look up ulcer 707.1X - the notes underneath say code, if applicable, any causal condition first.....diabetes mellitus>(249.80-249.81, 250.80-250.83). It doesnt mention the .70 at all?????? I'm very confused!


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## Anna Weaver (Jan 16, 2009)

*diabetes coding*

Unfortunately, this is another of those that the Dr. needs to indicate. You cannot relate them unless the Dr. indicates a causal relationship. At least that's the way I have been trained. If the physician says circulatory system disorder/disease and patient has diabetes, and patient has an ulcer, you code each one individually. If he says patient has diabetic ulcer due to circulatory system disease/disorder, then you would code the relationship with a 250.70 and the ulcer. 
Does this make more sense? Anyone else have anything to add? I know there are those who connect without direct wording from physician, but I do not.


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## katrinabgood (Feb 14, 2009)

I was taught the same way, Anna.  You may KNOW that the pt has a diabetic ulcer due to circulatory problems, but if the doc doesn't connect the dots, neither can you!  Just code each dx individually.


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## mgord (Apr 10, 2009)

Can anyone direct me to documentation so that I can educate the physicians on diagnosis code selection for these diabetic ulcers? I've spoken with them and let them know that they will have to tell me in their documentation which code I should use either .70 or .80. I still think I'm having a tough time understanding this concept myself!
If the doc says diabetic ulcer ankle, that would be 250.80 and 707.13 correct? If the same ulcer is described as diabetic ulcer ankle due to peripheral circulatory disorder, then it would be 250.70 and 707.13? Should there be some additional code for the circ d/o? 
Thanks for anyone who can offer any assistance, I really cant seem to wrap my head around this issue!


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## mitchellde (Apr 10, 2009)

What you have is an association issue.  If the documentation states the ulcer is due to a PVD which is due to Diabetes then you would have the 250.70, 443.81, 717.13.  You have to have all the proper associations listed so the question really is, is the ulcer due to the diabetes or due to the PVD?


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## rossman283 (Apr 4, 2014)

*Diabetic Anything*

If the Dr states "Diabetic -*****" then the link is established.  It is due to diabetes.
If he states "complicated by, due to, **** in diabetes", then it is covered.
Unless the manifestation is linked to the diabetes it is not diabetic.  Just listing a diagnosis and a manifestation is not enough.
Trust me, I have been fighting this one myself.


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