Q&A: ICD-10-CM coding for a necrotic pressure ulcer with diabetic complications

Q: A 63-year-old diabetic patient is diagnosed with a gangrenous decubitus ulcer of the left heel and admitted to the hospital for treatment. The provider's final diagnostic statement states, "stage 3 necrotic decubitus ulcer of left heel associated with diabetic neuropathy and peripheral vascular disease." Because the provider documented an association between diabetes and a decubitus ulcer, which condition would be sequenced as the principal diagnosis?

A: The coder would report ICD-10-CM code I96 (gangrene, not elsewhere classified) as the principal diagnosis because of the “code first” note under code category L89.- (pressure ulcer). The coder would then report ICD-10-CM code L89.623 (pressure ulcer of left heel, stage 3), as a secondary diagnosis.

The coder would assign codes E11.51 (Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene) and E11.40 (Type 2 diabetes mellitus with neurological complications) as additional diagnoses.

In this case, gangrene is associated with a pressure ulcer rather than diabetes mellitus. The primary reason for the admission was for treatment of the gangrenous pressure ulcer. This was not a diabetic ulcer.

Diabetic ulcers typically involve the foot and toes. Pressure ulcers develop in tissue near bony prominences, such as the elbows, tailbone, greater trochanters, or heels. Although diabetes mellitus may increase the risk of pressure ulcers because of its association with neuropathy and angiopathy, ICD- 10-CM doesn’t classify pressure ulcers the same way as diabetic ulcers.

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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