Diabetic ulver vs decubitus?

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
I have recently noticed that sometimes ‘diabetic foot ulcers’ are being coded as ‘pressure ulcers’. This does not seem correct to me. If a patient has PVD and a chronic non healing diabetic ulcer on their heel to the bone (MD states stage 4) should we be ending up with a stage 4 decubitus (704.24 & 707.07) or a heel ulcer (707.14)? This patient ended up undergoing an amputation.


Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • sbeattysbeatty
    edited May 2016
    Katy,

    Do you think is because the MDs are staging the diabetic ulcer? If so, that may be what the difference is. I would probably query if the diabetic ulcer due to xxx was also a pressure ulcer. I'm interested to see how others would handle this.

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Yes, I think because its staged, they assume it is a pressure ulcer but I do not see anywhere in the record where it is referred to as a decube or pressure ulcer. Documentation is explicit that this ulcer is relates to Diabetes, PVD and neuropathy.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • ddouthitddouthit
    edited May 2016
    Katy,
    So
    In order to capture the stage 4 the physician would have to call it a decubitus. There are not stages for diabetic ulcer. So if physician is stating Stage IV diabetic ulcer still just a 707.14.

    Dorie Douthit RHIT,CCS
    ddouthit@stmarysathens.org
    Clinical Documentation Specialist/HIM
    St. Mary’s Healthcare System
    1230 Baxter Street
    Athens, GA 30606
    706-389-3364


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    That’s what I thought Dorie. Just because it is staged, does not make it a pressure ulcer. And if I am not mistaken, ICD-10 will allow staging of other 'non-pressure' ulcers.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • ddouthitddouthit
    edited May 2016
    Katy,
    You are correct. ICD10 will allow you to specify depth of ulcer. i.e. limited breakdown of skin, necrosis of bone, etc... so with that being said, I would let my physicians keep documenting like they are and educate coding that just because staged doesn’t equal decubitus.

    Dorie Douthit RHIT,CCS
    ddouthit@stmarysathens.org
    Clinical Documentation Specialist/HIM
    St. Mary’s Healthcare System
    1230 Baxter Street
    Athens, GA 30606
    706-389-3364


  • lprescottlprescott
    You should query to clarify the type or etiology of ulcer. If decubitus then staging is appropriate.
    laurie l prescott RN,MSN, CCDS
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I am of the mind that no query is necessary. There is nothing to indicate that this was a pressure related ulcer. The documentation is clear that is it a diabetic ulcer related to PVD and neuropathy. So I think the MD did already state the etiology. A query could further confuse the issue and even appear 'leading' the MD to document an MCC without indication. I think the only reason there is a hang up is the staging. But staging does not mean that it is a decube. This is why I-10 will allow staging of other wounds.

    I'd love to hear other opinions on this though. This is a retro chart so I try to only place queries if necessary because they hold up the records. I feel it is somewhat different in the concurrent review process.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


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