When A Patient Presents With A DFU: How Will ICD-10 Change Your Documentation?

How will your documentation change going from ICD-9 to ICD-10?

The answer to this question really lies in how you have been documenting up until now. The rule to code to the highest specificity has not changed. The rule that your documentation must support the specificity of the code and justify the code has not changed either. ICD-10 gives us the ability to (and in some cases the requirement to) indicate the etiology, anatomic site, laterality, severity and progress of a pathology with our coding in instances when this was not always possible with ICD-9.

As of Oct. 1, coding for a diabetic foot ulcer will change as we move to the implementation of ICD-10. For example, if you see a patient with type 2 diabetes taking daily insulin for a chronic left lateral midfoot ulcer with necrosis of muscle, the ICD-9 codes would have been 707.14 (ulcer of midfoot, chronic) and 250.80 (type 2 diabetes with specified manifestations). Your documentation would need to support these codes by containing the corresponding terminology.

When coding this encounter with ICD-10, you would start with L97.423 (non-pressure chronic ulcer of left midfoot with necrosis of muscle) and see that the L97 codes require you to “Code first any associated underlying condition, such as diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622).” “Code first” indicates that an additional code is required and you should list this first. In this scenario, L97.423 mandates that you code first E11.621 (type 2 diabetes mellitus with foot ulcer).

We are still not finished because under E11.621, we see the direction to “Use additional code to identify any insulin use (Z79.4)” so we must also code Z79.4. If we use Z79.4, we must also support its use in our documentation. The documentation necessary to support 707.14 and 250.80 is different than what is necessary to support E11.621, L97.423 and Z79.4. The documentation we need to support the ICD-10 codes that we would not have needed to support the ICD-9 codes in this scenario include laterality, the fact that there is necrosis of muscle, the patient’s insulin use and that this is a non-pressure ulcer. These are points of documentation that some may not have been including under ICD-9 guidelines.

Reference

1. APMA Coding Resource Center. Available at https://www.apmacodingrc.org .

Editor’s note: This is an excerpt of a Practice Builders column, “Does Your Documentation Have To Change For ICD-10?,” that will appear in the October 2015 issue of Podiatry Today.