AHA Coding Clinic® for ICD-9 - 2004 Issue 1; Ask the Editor

Diabetes Mellitus with Decubitus Ulcer, Gangrene and Acute Osteomyelitis

A patient was admitted with complaints of continuous bleeding from a chronic ulcer of the left heel. The patient has non-insulin dependent diabetes, peripheral vascular disease due to the diabetes, end-stage renal disease, hypertension, and status post right above-the-knee amputation. Because of gangrene and acute osteomyelitis from the heel ulcer, the patient underwent a left below the knee amputation. If the physician documents that the ulcer is a decubitus ulcer, the ulcer should not be reported as a diabetic ulcer. However ICD-9-CM assumes a cause-and-effect relationship between osteomyelitis and the diabetes so that a diabetic complication code needs to be assigned for the same ulcer. Does the decubitus ulcer have to be reported as a diabetic ulcer simply because of the osteomyelitis? What are the diagnosis code assignments for this case? ...

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