Home Health ICD-9/ICD-10 Alert

Question: We are providing aftercare and dressing changes for a patient following the amputation of his right big toe. The patient is diabetic and has had the toe amputation due to gangrene. The gangrene is the result of the peripheral vascular disease secondary to diabetes. How should we code for him?

Michigan subscriber

Answer: Code for this patient as follows, says Conetoe, N.C.- based coding and billing specialist Vonnie P. Blevins, HCS-D, COS-C.

• M01020a: V58.49 (Other specified aftercare following surgery);  M1024: 250.70 (Diabetes with peripheral circulatory disorders; type II or unspecified type); and 785.4 (Gangrene);
• M1022b: 250.70;
• M1022c: 443.81 (Peripheral angiopathy in diseases classified elsewhere);
• M1022d: V58.31 (Encounter for change or removal of surgical wound dressing); and
• M1022e: V49.71 (Lower limb amputation status; Great toe).

Your primary reason for seeing this patient is to provide aftercare following his surgery. He had surgery to address the gangrene in his right big toe, so you'll list V58.49 for other specified aftercare because gangrene (785.4) doesn't fit under any of the other more specific aftercare codes, Blevins says.

The gangrene is the result of his diabetic peripheral vascular disease, and a diabetes diagnosis in M1020 pays more money than it does when listed in a secondary diagnosis slot. In this case, the diabetes code is replaced by the V code for aftercare in M1020, so you can list diabetes and gangrene in M1024 columns (3) and (4) to capture the case mix points, Blevins says.

The gangrene is resolved because the toe was amputated, so you shouldn't include it in M1022, Blevins says. But you can still code diabetes with peripheral circulatory disorders (250.70) and peripheral angiopathy (443.81) in M1022 because the patient still has diabetic angiopathy.

Also list the dressing change code (V58.31) and amputation status code (V49.71) to provide more information as to what type of surgery aftercare you are providing.