# DM mellitus hammertoe deformity



## arizona1 (Aug 1, 2011)

would you use 25080 for diabetes mellitus hammertoe deformity?
thank you


----------



## dadhich.girish (Aug 7, 2011)

Yes, 250.80 + 735.4.


----------



## btadlock1 (Aug 8, 2011)

arizona1 said:


> would you use 25080 for diabetes mellitus hammertoe deformity?
> thank you



I don't believe that hammertoe is listed as a specific manifestation of DM; the etiology/manifestation guidelines for 250.80 list additional codes: 707.10-707.9 (any associated ulceration), or 731.8 (diabetic bone changes). 
731.8 instructs you to use an additional code to specify the bone condition, and has examples listed from Acute Osteomyelitis (730.00-730.09), which doesn't appear to be quite the same thing as hammertoe. I could be wrong about that, though.

If the doctor specifically says the diabetes *caused *the hammertoe, then that's what you have to code; if that's the case, I'd probably assign 250.80, 731.8, 735.4. 

But, if he just listed that the patient has DM, and hammertoe, you may want to clarify whether he's saying that the DM is the underlying cause, or if it's merely a risk factor for complications, such as ulcerations or nerve problems. It may not be appropriate to list the DM as being classified with complications, if the DM isn't really causing the problems - it could make the patient's condition seem worse than it truly is, which could cause problems for them with their insurer in the future. 

We have a podiatrist that has a really hard time sequencing Dx codes for hammertoe/hallux valgus corrections, when patients are diabetic. Since the deformity being corrected isn't _caused by _the DM in most cases, he can't really sequence DM first; he's not treating the diabetes or a manifestation of the diabetes, but it is a relevant risk factor to the procedure in question. He typically lists the diagnosis for the procedure he's performing, with DM listed secondary (from 250.0x, not 250.8x). When we get these, we have to appeal them with commercial payers (Blue Cross, in particular), if the patient doesn't have coverage for routine foot care, and if the procedure is one that falls under that category with them. Hope that helps...


----------



## dadhich.girish (Aug 8, 2011)

I partially agree with Brandi.  There should be a relation between DM and hammer toe here per documentation.  Moreover, I do not agree with code 731.8, it per me should be used for disorders of bone due to bone loss.  Hammer toe is a deformity, which is associated with change of shape like hammer of phalanges and not necessarily related with bone loss.  Brandi may still be right, please research.

HTH.


----------



## btadlock1 (Aug 8, 2011)

dadhich.girish said:


> I partially agree with Brandi.  There should be a relation between DM and hammer toe here per documentation.  Moreover, I do not agree with code 731.8, it per me should be used for disorders of bone due to bone loss.  Hammer toe is a deformity, which is associated with change of shape like hammer of phalanges and not necessarily related with bone loss.  Brandi may still be right, please research.
> 
> HTH.



731.8 didn't feel right to me, either. I really doubt I would have gone for 250.80 in the first place, but I didn't have enough experience in the area to know that they're different, with certainty. 

The research I did didn't support DM and hammertoe as having a cause-and-effect relationship. I didn't find much on the correct way  to code it, though.


----------



## armen (Aug 9, 2011)

btadlock1 said:


> 731.8 didn't feel right to me, either. I really doubt I would have gone for 250.80 in the first place, but I didn't have enough experience in the area to know that they're different, with certainty.
> 
> The research I did didn't support DM and hammertoe as having a cause-and-effect relationship. I didn't find much on the correct way  to code it, though.



Agree with you and dadhich.girish. I work for an orthopaedic surgeon with 25 years of experience. 80% of our patients have DM. we do about 600-700 surgeries/year. A lot of bunions, hammertoes and other deformities of foot and ankle. 

None of our office notes or Op Report states anything like DM hammertoe. We usually bill 250.80 or just 250.00 as 2nd or 3rd Dx.


----------



## btadlock1 (Aug 9, 2011)

arme2783 said:


> Agree with you and dadhich.girish. I work for an orthopaedic surgeon with 25 years of experience. 80% of our patients have DM. we do about 600-700 surgeries/year. A lot of bunions, hammertoes and other deformities of foot and ankle.
> 
> None of our office notes or Op Report states anything like DM hammertoe. We usually bill 250.80 or just 250.00 as 2nd or 3rd Dx.



I didn't think that DM was a direct cause - thanks for clearing it up, though...With that in mind, I would only use 250.80 if the patient has a known condition manifesting from the DM, such as hypoglycemia, ulcerations, etc. Absent that information, I'd probably just stick with 250.0X, and for the doc repairing the hammertoe, I'd list the DM secondary to the hammertoe Dx.


----------



## armen (Aug 9, 2011)

btadlock1 said:


> I didn't think that DM was a direct cause - thanks for clearing it up, though...With that in mind, I would only use 250.80 if the patient has a known condition manifesting from the DM, such as hypoglycemia, ulcerations, etc. Absent that information, I'd probably just stick with 250.0X, and for the doc repairing the hammertoe, I'd list the DM secondary to the hammertoe Dx.



Correct! that is exactly what we do.


----------



## dadhich.girish (Aug 9, 2011)

I would personally agree with non-relational codes too, i.e., 250.0x and 735.4, but I usually follow documentation.  I have seen docs giving such weird documentations like these and I follow those with 250.8x codes and have never had any issues with billing.  Sometimes, you have to do some manipulations to accomodate doc's documentations.


----------

