05/29/2019
Correct Coding and Diagnoses for Diabetic Patient With Pressure Ulcer on Medication for Medicare, Commercial Insurances
I have a 3 part question. As part of the diagnosis codes, Medicare wants the ulcer code for a diabetic patient with an ulcer. So, if we put E11.621 or E10.621 we then need the ulcer code, and then the Z-code if the patient is on any meds. This is in conjunction with the CPT for the ulcer debridement. We must put the ulcer code, and in that order. Is this correct? Second part of the question is, do we need the ulcer code in the same scenario with commercial carriers or can we just put the E11.621 or E10.621 and no ulcer code? They pay without it, but I don't want to worry about anyone coming back saying it was needed. And the third part of the question is that for diabetic ulcer codes I was told to use only L97 not L89 codes, even if pressure is involved. Do you agree with that and what is the reasoning? Thank you.
- For the first and second part of the inquiry; this is not an insurance requirement when billing with ICD-10 codes E10.621 or E11.621- referring to any coding reference guide, it is specified that an ulcer code needs to be billed for DM with a foot ulcer because that specific diabetic diagnosis is a manifestation code that is incomplete from a billing and coding standpoint without a supplemental diagnosis to give additional information. In theory, no insurance (whether Medicare, Medicaid or commercial) should pay for any E&M or procedure if only the diabetic diagnosis is reported because as a Podiatrist you are not only treating their diabetes.
- For the third part of the inquiry; L97.XXX ulcer diagnosis codes need to be reported with E10.621 or E11.621 because those codes identify ulcers that are severe enough to be associated with diabetes. L89.XXX codes are more superficial ulcers that may or may not be caused by complications from diabetes. These are the guidelines outlined in any coding reference source when reviewing proper billing guidelines for diabetic ulcers.