Q&A: Reporting wound care procedures and office visits for diabetic patients
Q: If a patient is seen for a pressure ulcer on the foot related to diabetes, would you report a diabetes diagnosis code? If surgical debridement is performed and the patient receives treatment for their diabetes, can you charge for both an office visit and debridement?
A: In response to the first question, the underlying comorbidity that most closely relates to the wound is the diagnosis code that should be reported first. In this case, report the diabetes first using an ICD-10-CM code from Chapter 4 of the ICD-10-CM manual under the heading “Diabetes mellitus,” then the ulcer location using a code from Chapter 12 under the heading, “Other disorders of the skin and subcutaneous tissue.”
The following ICD-10-CM categories are used to classify and report diabetes mellitus:
- E08, diabetes mellitus due to underlying condition
- E09, drug or chemical induced diabetes mellitus
- E10, Type 1 diabetes mellitus
- E11, Type 2 diabetes mellitus
- E13, other specified diabetes mellitus
Location codes for pressure ulcers can be found under ICD-10-CM code category L89, pressure ulcer. There are several six-digit codes for pressure ulcers, which specify both the location and the stage of the ulcer.
In response to your second question, you can charge an office visit in addition to any procedure work only if the two are separately identifiable. If you’re doing something related to the diabetes (e.g., changing medications, addressing a nutritional aspect related to the diabetes), you can charge for a diabetes-related office visit in addition to the procedure. The separately identifiable work to justify the E/M service must be included in the provider documentation and not related to the procedure.
Editor’s note: Gloria Miller, CPC, CPMA, CPPM, vice president of reimbursement services at Comprehensive Healthcare Solutions, Inc., in Seattle, answered this question during the HCPro webinar, “Pressure Ulcer Coding: Strategies for ICD-10-CM Coding Accuracy.”