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Reader Question:

Get Codes in Order for Osteomyelitis

Published on Tue May 15, 2012

Question: Our patient fell and broke his hip. He also has type II diabetes. While recovering from the broken hip, he developed bilateral heel ulcers. He was treated at a wound care center, but the ulcers worsened. He had a sharp debridement of the right heel but his since developed osteomyelitis for which he is receiving antibiotics.

He is receiving home care for wound vac to the right heel following a calcanectomy and care for the remaining stage III decubitus ulcer on the left heel. How should we code this episode?

Georgia Subscriber

Answer: List the following codes for this patient:

  • M1020a: 730.07 (Acute osteomyelitis; ankle and foot);
  • M1022b: 707.07 (Decubitus ulcer; heel);
  • M1022c: 707.23 (Pressure ulcer stage III);
  • M1022d: 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled); and
  • M1022e V58.67 (Long-term [current] use of insulin).

Because the patient is still on antibiotics for the osteomyelitis, you'll begin by coding for this condition. So, your principal diagnosis is 730.07.

Coding guidelines allow you to assume that osteomyelitis is a manifestation of the diabetes only when no other reason exists for the osteomyelitis. However, in this case, the osteomyelitis is related to a pressure ulcer which is not a manifestation of diabetes.

Next, list 707.07 to indicate the remaining pressure ulcer and 707.23 for its stage.

Remember: A pressure ulcer is not a manifestation of diabetes, and you can't assume that just because a diabetic has an ulcer on the foot that it is a diabetic ulcer.

Finally, report V58.67 if the patient is on insulin. This V code should be included when your patient uses insulin to control type II diabetes.

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