Q&A: ICD-10-CM coding for acute cellulitis in a patient with Type 2 diabetes

June 28, 2019
Medicare Web

Q: A 79-year-old male with Type 2 diabetes mellitus presented due to acute cellulitis of the left lower leg. The patient was admitted and started on broad-spectrum antibiotics. When assigning the diabetes code, would it be appropriate to report the ICD-10-CM code for diabetes with skin complication not elsewhere classified (NEC). What is the appropriate ICD-10-CM code assignment for acute cellulitis in a patient with Type 2 diabetes?

A: To link the diabetes and the cellulitis, the provider would need to document cellulitis as a diabetic skin complication. When the causal relationship is unclear, query the provider regarding the linkage and whether cellulitis is a skin complication caused by the diabetes.

The relationship between diabetes and cellulitis should be clearly documented by the provider. When the coder is unable to determine whether a condition is a diabetic complication, or the ICD-10-CM classification does not provide instruction, it is appropriate to query the physician for clarification so that the appropriate codes may be reported.

Per Coding Clinic, Fourth Quarter 2017, pp. 100-101, coding professionals should not assume a causal relationship when the diabetic complication is NEC. The ICD-10-CM classification presumes a cause-and-effect relationship with specific conditions when the Alphabetic Index links the conditions using the termswith,” “due to,” or “associated with.”

Editor’s note: Sarah Humbert, RHIA, AHIMA-certified ICD-10-CM/PCS trainer, coding and compliance manager at KIWI-TEK LLC, and Temeka Davis, RHIT, coding manager at KIWI-TEK LLC, answered this question during HCPro’s webinar Simplify Complex ICD-10-CM Coding for Diabetes.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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