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Home Health ICD-9/ICD-10 Alert

You Be The Coder ...Diabetes And Surgery - Here's A Coding Challenge

Published on Fri Nov 26, 2004

Question: A patient with Type II diabetes is admitted to home care following an amputation of three toes due to a gangrenous diabetic ulcer. The patient has been diagnosed with peripheral vascular disease and has chronic obstructive pulmonary disease that is stable. The primary care will be dressing changes, but the nurse also will teach the patient how to prevent further ulcers.

Answer: You should code the following:

 

  • M0230 - V58.3 (Attention to surgical dressings and sutures) 
     
  • M0240b - V58.73 (Aftercare following surgery, circulatory system, NEC)  
     
  • M0240c - 250.70 (Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled)
     
  • M0240d - 443.81 (Peripheral angiopathy in diseases classified elsewhere)
     
  • M0240e - V49.72 (Lower limb amputation status, other toe[s])
     
  • M0240f - 496 (Chronic airway obstruction, not elsewhere classified)
     
  • M0245a - 250.70 ( Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled)
     
  • M0245b - 785.4 (Gangrene)
     
    The dressings are the primary reason for home care, so V58.3 would go first, explains Laresa Boyle, director of coding services at Longview, TX-based Healthcarefirst. V58.73 is next, because the amputation was due to gangrene from the diabetic peripheral vascular disease. Don't put 785.4 in M0240, because gangrene is no longer there, following the amputation, but PVD is still likely to be a problem, she says.

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