Home Health ICD-9/ICD-10 Alert

Question: We have a patient diagnosed with peripheral venous disease. This patient previously had ulceration (454.2) and cellulitis (682.6) of lower extremities and an additional diagnosis of venous (per-ipheral) insufficiency (459.81).
 
The patient's ulcerations have healed, cellulitis is resolved, but we want to continue to see the patient to assess lower extremities for possible breakdown. He has advanced trophic changes (782.9) and absent pedis pulse (785.9), so he can qualify for routine foot care coverage if the peripheral venous disease is a qualifier for (440.20) atherosclerosis of extremities, unspecified. 

In looking up the 440 diagnoses in my ICD-9 book, it states, "Includes arteriosclerotic vascular disease" and "includes degeneration--vascular." 

Do you see this as qualifying for further skilled coverage for evaluation of lower extremities?

Answer: Your patient appears to have both venous and arterial insufficiency. You should continue to report the venous insufficiency (459.81).
 
The patient has all the signs of arterial insufficiency also, with the trophic changes and the absent pedal pulse. Clarify the diagnosis of arteriosclerotic vascular disease with the physician. These diagnoses will qualify the patient for foot care. Use codes 440.2x (Atherosclerosis, of native arteries of the extremities) and 459.81 (Venous [peripheral]) insufficiency, unspecified).