Home Health ICD-9/ICD-10 Alert

Question: Our new patient fell and broke his hip. During his recovery, he developed bilateral heel ulcers. He was treated at a wound care center, but his ulcers worsened. He had a sharp debridement of the right heel but later developed osteomyelitis. He is receiving home care for wound vac to the right heel following a calcanectomy and care for the remaining decubitus on the left heel. He also has type II diabetes. How should we code for him?

-- Florida Subscriber

Answer: Assuming that the osteomyelitis requires no further treatment post-calcanectomy, you'll code for the pressure ulcers as the focus of the home care with 707.07 (Decubitus ulcer; heel), says Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, consultant and principal of Selman-Holman & Associates in Denton, TX.

Your patient's other diagnoses include diabetes -- 250.00 (Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled) -- and V54.13 (Aftercare for healing traumatic fracture of hip), plus the fracture -- 820.8 (Fracture of neck of femur, unspecified part of neck of femur, closed) listed in M0246, Selman-Holman says.

However, if your agency is providing aftercare following the calcanectomy, you could list V58.78 (Aftercare following surgery of the musculoskeletal system, NEC) as primary if it's the primary focus of care or secondary if the pressure ulcers are the focus of care, Selman-Holman says.

ICD-9-CM assumes that osteomyelitis is a complication of diabetes when no other cause is stated. However, in this case the osteomyelitis is associated with pressure ulcers, which are not considered manifestations of diabetes.

You can code for osteomyelitis in M0246 across from V58.78. But you would only list a code for osteomyelitis in M0240 if it wasn't resolved by previous treatments.