Home Health ICD-9/ICD-10 Alert

Avoid listing V58.30 as principal.

Coding for diabetic ulcers was already confusing and the way points are assigned with the new prospective payment system grouper adds even more complexity.

There's an issue with diabetes and ulcers in the PPS grouper, says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX. Medicare defines a manifestation as one listed in italics in the tabular list or one with a capital M in the case mix list. But ulcers aren't indicated as a manifestation in either notational style, so you'll get points for ulcer and diabetes, she says.

However, the grouper will only give points for M0246(3) or M0246(4) -- not both, Selman Holman says. So if you list a V code such as V58.30 (Encounter for change or removal of nonsurgical wound dressing) in a M0240 slot and have diabetes code 250.8.x (Diabetes with other specified manifestations) in M0246(3) followed by ulcer code 707.1x (Ulcer of lower limbs, except decubitus) in M0246(4), you'll only receive points for the diabetes. Reminder: V58.30 is not appropriate as a primary code in most cases. It is a reason-for-encounter code and should be sequenced near or at the bottom.

Bottom line: You must list the diabetes and ulcer codes in the M0230 and M0240 slots in order to receive points for both.

Another tip: With detailed physician documentation, you can code more specifically for diabetic ulcers. If the documentation links the ulcer to the circulatory problems associated with diabetes, then you can report 250.7x (Diabetes with peripheral circulatory disorders) and the ulcer code. If the documentation links the ulcer to the neurological problems associated with diabetes, then you can list 250.6x (Diabetes with neurological manifestations) and the ulcer code.

Caveat: Medicare only accepts fourth digit "8" in the diabetes code for ulcers to gain supply severity points, so it's best to code diabetic ulcers with 250.8x and 707.1x, Selman-Holman says.