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Home Health ICD-9/ICD-10 Alert

Reader Question:

Read the Notes for Arteriosclerotic Ulcer Sequencing

Published on Sun Jan 21, 2001

Question: Our new patient has an ulcer of the ankle due to atherosclerosis, essential hypertension, and senile macular degeneration. Our nurse visits three times a week for wound care which is the focus of care. She also performs blood pressure checks every visit, provides teaching on disease process, prefills the medication box and monitors for medication reaction. How should we code for this patient?

Tennessee Subscriber

Answer: Code for this patient as follows:

  • M1020a: 440.23 (Atherosclerosis of the extremities with ulceration);
  • M1022b: 707.13 (Ulcer of ankle);
    •
  • M1022c: 401.9 (Essential hypertension; unspecified); and
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  • M1022d: 362.50 (Macular degeneration [senile], unspecified).

The ulcer is the main focus of care, so 440.23 is your principal diagnosis. Notes next to this code advise you to "Use additional code for any associated ulceration (707.10-707.9)."

So, next you should list 707.13 to indicate that your patient has an ankle ulcer as a result of her arteriosclerosis. Instructions under 707.13 advise you to "code any causal condition first" which means that the cause of the ulcer (in this case atherosclerosis) must be coded first followed by the ulcer code.

Next, list 401.9 to indicate that your patient has hypertension, and then report her senile macular degeneration with 362.50. Make certain that the plan of care details how these comorbidities impact the care your agency provides, as well as an interventions to address them.

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