Home Health ICD-9/ICD-10 Alert

Question: We have a patient who has diabetes with neuropathy. Due to the decreased sensation in her extremities, she has developed pressure ulcers in addition to diabetic ulcers. The physician has used the diagnosis of "diabetic pressure ulcer." How do we code this?
 
Answer: The answer to your question depends on where the diabetic pressure ulcer is located. If an ulcer is on the front of the foot, rather than the heel, it is considered a diabetic ulcer and you should code it with 250.8x (Diabetes with other specified manifestations), 707.15 (Ulcer of other part of foot).
 
If the ulcer is located anywhere other than the front of the foot, it's up to the physician whether to call the ulcer a pressure ulcer OR a diabetic ulcer. If you're unsure, ask the physician for an exact diagnosis.
 
Remember: You'll have to stage a pressure ulcer, but not a diabetic ulcer. And pressure ulcers are not manifestations of diabetes.
 
Keep in mind that diabetes may, however, cause arterial ulcers and neuropathic ulcers. Use the "Quick Assessment of Leg Ulcers Fact Sheet" available from the Wound, Ostomy and Continence Nurses Society (www.wocn.org/publications/facts/pdf/C_QUICK1.pdf) to better assess the ulcer and then call the physician and discuss the assessment compared to the fact sheet.