Home Health ICD-9/ICD-10 Alert

Question: How should we code diabetic neuropathic ulcers? I know how to code diabetic ulcers, and I know how to code diabetic neuropathy. I have been coding diabetic neuropathic ulcers as 250.6x, 357.2, 707.1x. My reasoning is that the diabetic neuropathy is the underlying cause of the ulcer. Am I coding correctly?

Answer: When a diabetic neuropathic ulcer is the focus of care, you would code for it as follows:

• 250.6x (Diabetes with neurological manifestations);

• 707.1x (Ulcer of lower limbs, except decubitus);

• 357.2 (Polyneuropathy in diabetes).

But these codes are only appropriate if you have documentation from the physician on the relationship between the neuropathy and the ulcer.

Take note: Eight is the default fourth digit for a diabetic ulcer and the only fourth digit that brings nonroutine supply points under the PPS refinement rule. The coding guideline that instructs you to code diabetic ulcers more specifically when you have specific information indicating whether the etiology is neurological or circulatory is a permissive guideline, and you always have the option of using a fourth digit of eight instead.