would you use 25080 for diabetes mellitus hammertoe deformity?
thank you
I don't believe that hammertoe is listed as a specific manifestation of DM; the etiology/manifestation guidelines for 250.80 list additional codes: 707.10-707.9 (any associated ulceration), or 731.8 (diabetic bone changes).
731.8 instructs you to use an additional code to specify the bone condition, and has examples listed from Acute Osteomyelitis (730.00-730.09), which doesn't appear to be quite the same thing as hammertoe. I could be wrong about that, though.
If the doctor specifically says the diabetes
caused the hammertoe, then that's what you have to code; if that's the case, I'd probably assign 250.80, 731.8, 735.4.
But, if he just listed that the patient has DM, and hammertoe, you may want to clarify whether he's saying that the DM is the underlying cause, or if it's merely a risk factor for complications, such as ulcerations or nerve problems. It may not be appropriate to list the DM as being classified with complications, if the DM isn't really causing the problems - it could make the patient's condition seem worse than it truly is, which could cause problems for them with their insurer in the future.
We have a podiatrist that has a really hard time sequencing Dx codes for hammertoe/hallux valgus corrections, when patients are diabetic. Since the deformity being corrected isn't
caused by the DM in most cases, he can't really sequence DM first; he's not treating the diabetes or a manifestation of the diabetes, but it is a relevant risk factor to the procedure in question. He typically lists the diagnosis for the procedure he's performing, with DM listed secondary (from 250.0x, not 250.8x). When we get these, we have to appeal them with commercial payers (Blue Cross, in particular), if the patient doesn't have coverage for routine foot care, and if the procedure is one that falls under that category with them. Hope that helps...
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