Dm type 1 and Charcots foot

danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
in Home Care Coding General
My patient has DM type 1 and has a diagnosis of left Charcot's foot, I know I cannot assume this relationship but the only code I come to is A52.16 which the coding tip states only to use this code if Charcot's is caused by syphilis. Can someone please help me in the worst case scenario if no response to my query?

Thanks!

Danie Stevens
Home Health Coder, RHIT
Essentia Health St. Mary's
114 Frazee Street East Detroit Lakes, MN 56501
218-314-7857
Danielle.Stevens@essentiahealth.org

Comments

  • cbrunk@totalhh.comcbrunk@totalhh.com
    edited April 2017
    Look at E10.610-DM Type 1 with Diabetic Neuropathic Arthropathy
    Coding Tip states do not code Charcot's Joint

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    So code this instead?
  • cbrunk@totalhh.comcbrunk@totalhh.com
    edited April 2017
    Yes it is a combination code

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    And wouldn't the MD have to state the relationship of the charcots foot?
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    I don't have documentation of the relationship, im wondering what I would use if they have both dx but the MD does not say diabetic charcots.
  • cbrunk@totalhh.comcbrunk@totalhh.com
    edited April 2017
    My understanding of the guidance with regards to the term "with in the index" if patient has DM and Charcots foot you may code as combination code. I may be wrong and hopefully Vonnie will chime in here and help us both, but that was my understanding when they came out with the new/revised guidance regarding DM and manifestations

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    This is where I get confused with the diabetes! Thank you for your help :)
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    Would this be correct below?

    My understanding of the guidance with regards to the term “with in the index” if patient has DM and Charcots foot you may code as combination code. I may be wrong and hopefully Vonnie will chime in here and help us both, but that was my understanding when they came out with the new/revised guidance regarding DM and manifestations

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • cbrunk@totalhh.comcbrunk@totalhh.com
    edited April 2017
    Vonnie, another question for you; MD documents “Chronic Pathological Fracture Left Leg” and gives the code M84.40XA wouldn’t I use the pathological fracture of the left leg

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    Assessment: Ulceration bilateral feet, diabetes type 2 with neuropathy, Charcot foot left.

    ^^^I don’t think “with” applies here, this is my biggest problem!
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    I did forget to ask what code would I use if its not in relation to the DM?
  • cbrunk@totalhh.comcbrunk@totalhh.com
    edited April 2017
    But it does. You would code this one as

    DM with ulcer to foot
    Code the wounds
    DM with Neuropathy
    DM with Charcots Arthropathy

    Priscilla Brunk RN, HCS-D
    Corporate Coder
    Cell: 772-284-1185
    Fax: 954-962-2667
  • danielle.stevens@essentiahealth.orgdanielle.stevens@essentiahealth.org
    edited April 2017
    So confusing im literally looking for “with”

    Thanks ☺
  • lkpengellkpengel
    edited April 2017
    “With” does apply here. Charcot’s joints is under the sub-term “with”. The code is E10.610. Ulcer code E10.621.
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