Wiki DM II w/ amputation

[kerenorozco]

Good morning I am new to HCC coding. I have a provider asking my input on the following
DM with BKA 2019 right leg, left toes amputation 2019 - metformin 500mg po bid
I am not sure if I can add E11.51 w/ the amputation or how should it be coded
any help would be aprreciate it
thank you\

 

[thomas7331]

Based on what information you have here, the E11.51 would not be supported. You can report the right BKA with Z89.511, but you can't assume that the patient has the vascular complications of the DM unless the provider has so stated. A BKA in the past could have been done for any number of reasons, which may or may not have been related to the diabetic condition.

 

[kerenorozco]

Based on what information you have here, the E11.51 would not be supported. You can report the right BKA with Z89.511, but you can't assume that the patient has the vascular complications of the DM unless the provider has so stated. A BKA in the past could have been done for any number of reasons, which may or may not have been related to the diabetic condition.

Thank you for your response
Yes my provider is asking my help bc for her the amputation was due to DM II
I kept looking and found E11.618 plus Z89.511
I just dont know if that information is enough

 

[thomas7331]

Thank you for your response
Yes my provider is asking my help bc for her the amputation was due to DM II
I kept looking and found E11.618 plus Z89.511
I just dont know if that information is enough

The provider needs to document what the patient's conditions are at the current encounter and codes can only be assigned based on that. You can't assume that any conditions that caused the amputation back in 2019 are still present unless the provider has said so for this encounter. If the only thing documented is DM II and a history of a right BKA, then the only codes that can be reported are E11.9 and Z89.511. E11.618 is not supported by a history of a BKA, even if it was caused by the DM.

 

[kerenorozco]

The provider needs to document what the patient's conditions are at the current encounter and codes can only be assigned codes based on that. You can't assume that any conditions that caused the amputation back in 2019 are still present unless the provider has said so for this encounter. If the only thing documented is DM II and a history of a right BKA, then the only codes that can be reported are E11.9 and Z89.511. E11.618 is not supported by a history of a BKA, even if it was caused by the DM.

Awesome thank you so much!!