Home Health ICD-9/ICD-10 Alert

Know when to look for cause-and-effect documentation.

While you generally can’t assume your diabetic patient’s co-morbidities are manifestations, there are two exceptions to this rule. If your patient has both diabetes and either osteomyelitis or gangrene, you can assume these conditions were caused by the diabetes. But be careful not to go overboard with your assumptions.

Background: When a patient has both osteomyelitis or gangrene and diabetes, and the physician doesn’t document any other cause for the osteomyelitis or gangrene, you can assume the diabetes is the cause, and code for the condition as a manifestation.

When you look up the keyword “diabetes” in the alphabetic index of your ICD-9 coding manual, the first sub-term you’ll see is “with.” In the ICD-9 vernacular, you can assume conditions listed under “with” are linked to the corresponding keyword entry. In the case of diabetes, you’ll find both that osteomyelitis and gangrene fall into this elite group.

On the other hand, ulcers, edema, retinopathy, and the many other conditions that can be manifestations of diabetes aren’t listed under the sub-term “with” for the keyword “diabetes.” The physician must document a link before you can assume a cause-and-effect relationship with these conditions.