Home Health ICD-9/ICD-10 Alert

Question: For a patient with a diabetic ulcer for whom we're doing dressing changes and education and who is insulin-dependent, which diagnoses go in which columns for M0246?

Answer: In your scenario, you won't place any codes in M0246. If the focus of care is diabetic ulcer, then you should code as follows:

M0230/M0240

• 250.80 (Diabetes with other specified manifestations; type II or unspecified type, not stated as uncontrolled);

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

• V58.30 (Encounter for change or removal of non-surgical wound dressing); and

• V58.67 (Long-term [current] use of insulin).

Reason: The focus of care is the diabetic ulcer, so you should code for diabetes and the manifestation first.

Avoid using the V codes for dressing changes as primary for two reasons. First, you shouldn't use a V code as primary when a code for the actual diagnosis is a better choice. And second, you shouldn't use the V code for dressing change as primary unless the sole reason for care is a dressing change. This should never be the case.

The underlying conditions to the V codes V58.30 and V58.67 are the diabetes and the ulcer, but since the diabetic ulcer has already been coded, M0246 may be left blank.

Following the OASIS coding instructions, in this scenario, a V code replaced a case mix diagnosis, so you could complete M0246. But M0246 is optional, and because the case mix points for diabetes and ulcer have already been counted, you can leave M0246 blank.