Home Health ICD-9/ICD-10 Alert

Question: Our new patient has diabetic polyneuropathy and diabetic ulcers on her toes. The ulcers are the focus of our care. Her diabetes is a result of having part of her pancreas removed. She requires insulin to manage her diabetes. How should we code for her?

Answer: For this patient, list the following diagnosis codes:

• M1020a: 251.3 (Postsurgical hypoinsulinemia);
• M1022b: 249.80 (Secondary diabetes mellitus with other specified manifestations; not stated as uncontrolled, or unspecified);
• M1022c: 707.15 (Ulcer of toes);
• M1022d: 249.60 (Secondary diabetes mellitus with neurological manifestations not stated as uncontrolled, or unspecified);
• M1022e: 357.2 (Polyneuropathy in diabetes);
• M1022f: V58.67 (Long-term [current] use of insulin);

Other pertinent diagnoses: V45.79 (Other acquired absence of organ).

Your patient's diabetic ulcers may be the focus of your care, but because they are manifestations of her diabetes, you won't code for them in M1020.

In this case you'll have to trace the cause of the ulcers back further than you would for a patient with primary diabetes. Secondary diabetes caused the ulcers, and the removal of part of the patient's pancreas caused the secondary diabetes.

The official coding guidelines instruct you to list 251.3 for postpancreatectomy diabetes mellitus or lack of insulin due to the surgical removal of all or part of the pancreas, so this will be your principal diagnosis.

The coding guidelines also instruct you to list a code from the 249.xx (Secondary diabetes) for patients with postsurgical hypoinsulinemia so you'll list 249.80 next because it is the appropriate secondary diabetes code to link with the 707.1x code to indicate diabetic ulcers.

Next, you'll need to list a second 249.xx code to indicate that your patient also has a neurological manifestation due to diabetes. Follow this with 357.2 to indicate the specific manifestation --  polyneuropathy.

Instructions in the tabular list of your ICD-9 manual under 251.3 will ask you to list V58.67 to identify any associated insulin use, so list this next.

Finally, the coding guidelines also require you to list V45.79 for the acquired absence of the pancreas when reporting a patient with postpancreatectomy diabetes, so list this as an additional diagnosis.