THE CODING EDGE® ARCHIVES

Table of Contents
 
Attention! A big THANK YOU
to Christine W. who codes
at Mercy Hospital in Springfield, Massachusetts

   

Procedure Practice 08/15/98 - Feature Article 08/15/98
   

Procedure Practice 08/15/98:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify this episode of treatment. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale

Note: It is important to remember that diabetes mellitus with complicating conditions in the 250.4x to 250.8x range is always coded first to the correct diabetic code to identify the etiology of the complication, and then to the manifestation code to identify the specific complicating condition.

  
Diagnoses

The patient was admitted to treat his diabetic foot ulcer. The physician states that the underlying cause of the ulcer is diabetic peripheral neuropathy. Diabetic foot ulcers due to diabetic neuropathy are coded first to the appropriate diabetes code, in this case 250.61. The specific manifestation of this patient’s diabetic neuropathy is his toe ulcer with gangrene. Therefore, code the ulcer as the secondary diagnosis, 707.1, followed by the code for gangrene, 785.4. His work-up revealed acute osteomyelitis of the 2nd and 3rd metatarsal bones in addition to the ulcer. First code the diabetic etiology to 250.81, Diabetes with other specified manifestations. Acute osteomyelitis of the metatarsals requires two codes to correctly identify the condition as secondary to diabetes: 731.8, Other bone involvement in diseases classified elsewhere, and 730. 07, Acute osteomyelitis of ankle and foot.

The patient also had Kimmelstiel-Wilson syndrome secondary to his diabetes. In the Disease Index, "Syndrome, Kimmelstiel-Wilson (intercapillary glomerulosclerosis)" directs the coder to 250.4 and [581.81]. The 5th digit of "1" to indicates that IDDM is needed, so 250.41, Diabetes with renal manifestations, followed by 581.81, Nephrotic syndrome in diseases classified elsewhere, are the correct codes.

To review the sequence of diagnosis codes:
250.61, 707.1, 785.4, 250.81, 731.8, 730.07, 250.41, 581.81.

   

ICD-9-CM Procedures

The patient underwent a forefoot amputation. In the Procedure Index under "Amputation, forefoot," the coder is directed to code 84.12. A review of the tabular entry shows that this is the correct code: Amputation through foot … including transmetatarsal amputation. The patient also required a hemodialysis treatment while in the hospital, coded 39.95, Hemodialysis.
  

CPT-4 Procedures

In the CPT index, the entry for "amputation, foot" refers to a range of codes: 28800 to 28805. The accompanying text for each code verifies that 28805 is the correct procedure code: Amputation, transmetatarsal.

Hemodialysis is found in the Medicine section of the CPT book. Assign code 90935 for the single dialysis session.

Procedure Practice 08/15/98 - Feature Article 08/15/98

Bibliography - References:
Coder’s Desk Reference, Medicode Publishing, Salt Lake City, UT.
Code It Right, Medicode Publishing, Salt Lake City, UT
Coding Clinic, 3rd Qtr. 1991; 4th Qtr. 1993; American Hospital Association, Chicago, IL.
CPT 98 Physicians’ Current Procedural Terminology, American Medical Association, Chicago, IL.
St. Anthony’s Illustrated ICD-9-CM Code Book, St. Anthony’s Publishing, Reston, VA.		 Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

Please be aware that the Coding Edge® Archive pages are NOT retroactively updated
to reflect possible coding rules and regulation changes made after the publishing date.