Home Health ICD-9/ICD-10 Alert

Question: How should we code when a diabetic patient has debridement or amputation to treat a wound with osteomyelitis? For example, we are caring for a patient who has type II diabetes. He had a stage IV pressure ulcer on his right heel with osteomyelitis. He had a sharp debridement of the right heel, and is receiving antibiotics. Should we include a code for the osteomyelitis?

South Dakota Subscriber 

Answer: Your question brings up a number of coding issues. First off, coders often get confused about whether a debrided pressure ulcer is considered a surgical wound. Debridement does not turn a pressure ulcer into a surgical wound. Instead you should code based on the wound’s origin. And in this case, your patient’s pressure ulcer should always be reported at its worst stage; stage IV.

Next, there is the coding convention that allows you to assume that osteomyelitis (or gangrene) is a manifestation of diabetes when no other reason exists for the osteomyelitis. In your patient’s case, however, the documentation indicates that the osteomyelitis is related to his pressure ulcer, so you cannot assume the osteomyelitis is a manifestation of diabetes.

Why? Your patient’s osteomyelitis is related to the pressure ulcer which is not a manifestation of diabetes. 

You can’t assume that just because a diabetic has an ulcer on the foot that it is a diabetic ulcer.

Finally, you’ll need to consider whether the patient still has the osteomyelitis (or gangrene) after the debridement.In your patient’s case, he is receiving antibiotics to treat the osteomyelitis, so you can code for it as a current diagnosis.

List the following codes for your patient:

• 730.07 (Acute osteomyelitis; ankle and foot);
• 707.07 (Pressure ulcer; heel); 
• 707.24 (Pressure ulcer stage IV);
• 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled).

In ICD-10 for this patient, you would list the following codes:

• M86.171 (Other acute osteomyelitis; right ankle and foot);
• L89.514 (Pressure ulcer of right ankle, stage 4); and
• E11.9 (Type 2 diabetes mellitus without complications).

In ICD-10, one code will report both the pressure ulcer and its stage.