# Diabetes with peripheral circulatory disorders - To my understanding whenever Diabete



## siddika_82@hotmail.com (Oct 20, 2010)

Hi, 

To my understanding whenever Diabetes is mentioned with gangrene or osteomyelitis, The doctor does not necessarily have to mention the relationship you can code it directly 250.70 for diabetes with peripheral circulatory disorders and 785.4 for gangrene. 

The patient that I am coding has gangrene of LE, Ulcer of heel and midfoot and PVD. This patient is a diabetic patient. This patient also has Diabetic neuropathy of LE. 

My question is is the PVD coded, and if yes should i assign code 443.9 or 443.81? is the relationship between PVD and diabetes related automatically or does the doctor have to state it. 
But also i know that form my knowledge the gangrene and ulcers result from PVD for a patient with Diabetes. 

According to me i would code it as 250.70 + 785.4 + 707.14 and use 250.60 + 337.1

Any help would greatly be appreciated. 

Thank you
Sidika


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## gost (Oct 20, 2010)

Hello Sidika.  That is my understanding as well.  I believe you are correct.


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## ohn0disaster (Oct 20, 2010)

I would have to see the exact documentation that the doctor provided to be sure of what I would code but here's my 2 cents. 
I'm unsure as to if I'm reading your question correctly. Are you asking if the complication must be linked, by the doctor's documentation, to the diabetes? The answer is yes, the doctor must link. We cannot assume, as coders, that they are linked. Assumption coding has been discussed through the forums frequently and has always been a no-no. I'll use an example from Ingenix 2011 Coder's Desk Reference.

*Diabetic Ulcers:* Diabetic patients may develop ulcers from conditions such as diabetic neuropathy (250.6x), diabetic peripheral vascular disease (250.7x). However, diabetic ulcers, including diabetic foot ulcers, are reported with code 250.8x or 249.8x and the appropriate code from the category 707. Instructional notes in the ICD-9-CM text state "Use additional code to identify any manifestation as; any associated ulceration (707.10 - 707.9)." *Note that not all ulcers in diabetic patients are diabetic ulcers.* If there is a question regarding the linkage of the conditions, query the physician.
_________________________________________________________________________

All the conditions that you mentioned can be linked to the diabetes. If the doctor failed to link, I would bring it to his/her attention and ask if the conditions are due to diabetes and, if so, please link them to DM. Merely documenting all conditions on an encounter is not enough. You must state cause and effect.

Appropriate ways to link:
PVD due to DM
Diabetic PVD
PVD secondary to DM
Diabetes with PVD
PVD in Diabetes

Do not link if it is documented as such:
Diabetes
Ulcer of foot
PVD

Hope this helps.


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## gost (Oct 20, 2010)

Vanessa, you are right.  In fact, I just posted info about assumption coding in response to another post.  When I first started coding, I was told by my emloyer (I have since moved on) that if DM and a related dx like PVD were documented that you could link them (this did not apply to skin ulcers).  I have been operating that way ever since without even thinking about it.  Hearing someone explain otherwise makes sense and makes me wonder why I never realized it before.  Thanks!


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## siddika_82@hotmail.com (Oct 20, 2010)

Thank you Vanessa I got my answer. Thank you Guru.

Have a good day


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