Part B Insider (Multispecialty) Coding Alert

Keep ICD-9 subterms in mind when reporting these conditions

Question: How should I code diabetic manifestations such as osteomyelitis? People in our office have different opinions, and I don't know who is correct.

Answer: Coding manifestations and related conditions with diabetes mellitus can be confusing. The underlying principle for coding all diagnoses is to rely on physician documentation. This provides the basis for navigating the ICD-9-CM guidance. In the Alphabetic Index, the connecting word -with- is sequenced before other subterms. Look up -Diabetes- in the Alphabetic Index and note that, under the first subterm -with,- the manual lists specific conditions, including osteomyelitis.

When a patient has osteomyelitis with diabetes mellitus, ICD-9-CM assumes a relationship between the diabetes and the osteomyelitis. This is true unless physician documentation in the health record has indicated that the osteomyelitis is totally unrelated to the diabetes.

For example: A patient presents with a diagnosis of diabetes mellitus with acute osteomyelitis on the right ankle. The correct coding for this encounter would be:

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

- 731.8--Other bone involvement in diseases classified elsewhere

- 730.07--Acute osteomyelitis; ankle and foot.

Another example: Your patient has type II diabetes mellitus and acute osteomyelitis due to a pressure ulcer (decubitus) of the heel. Be-cause the documentation indicates that the cause of the osteomyelitis is the pressure ulcer, you wouldn't code the osteomyelitis as a diabetic complication. Not all ulcers in a diabetic patient are diabetic ulcers. For this patient, you would assign:

- 707.07--Decubitus ulcer; heel

- 730.07--Acute osteomyelitis; ankle and foot

- 250.00--Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled.

You should look for terminology such as -diabetic manifestation- (such as retinopathy), -manifestation secondary to diabetes- and -manifestation due to diabetes- in your documentation to support coding diabetes mellitus as the underlying cause of a manifestation.