Wiki Diabetes "linking"

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jfuller39

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Hello,
Having a bit of a debate between us coders about what is considered "linked" to diabetes. The following three dxs are being debated: hypoclycemia, gangrene, osteocyt. Though these may all be in of themselves dxs stand alone, if they are in a pt with diabetes, are they automatically considered "linked"?

Thanks!
 
I would not link them unless physician states a linking term, such as with.

ie Diabetic neuropathy with gangrene

just because a patient is diabetic, does not mean the other diagnosis are related/caused by the diabetes, unless physician states it.

Cordelia, CCS, CPC
 
Ok, that was my argument, since you can have any of them without diabetes, it can't be assumed linked unless that is expressly mentioned. I haven't been able to find an actually answer to back up my answer so wanted to put it out there for other coders.

Thanks a lot.
 
Without specific documentation from the provider it is not up to the coder to determine is a condition is caused by the diabetes or not caused by the diabetes. This is not something that will be written nor does it need to be explicitly written. The coder is not a physician and therefore cannot make a specific diagnosis about a patient. In otherwords, it is not up to the coder to determine if a condition is causal to the underlying condition or not.
 
Diabetes linking

ICD-9-CM assumes a relationship between diabetes and osteomyelitis when both conditions are present, unless the physician has indicated the acute osteomyelitis is totally unrelated to the diabetes. (See Coding Clinic, first quarter 2004, pages 14 and 15.)


Gangrene/diabetes

If no other cause and effect relationship has been established for the gangrene in a diabetic patient, assume that the gangrene is the consequence of a diabetic peripheral vascular circulatory disorder, and code 250.7x and 785.4, gangrene.
If a traumatic open wound became infected and progressed to gangrene, code as an open wound, complicated with 785.4, gangrene, and the appropriate diabetic code 250.xx.
(See Coding Clinic, March-April 1986, page 12.)

Hypoglycemia is also an assumed consequence of diabetes.
 
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