Cellulitis in a diabetic patient

cindys@hollandhospital.org

Cellulitis

• The ICD-10 Code book index now assumes a relationship for all conditions listed “With” under the heading of Diabetes

• Cellulitis is not in the list

• However, “Skin complication, NEC” is in the list

• CODING CONUNDRUM:  Is Cellulitis intentionally and clinically omitted ?  Or is Cellulitis included in “Skin complication, NEC?” 

• CDI CONUNDRUM:  Should every patient with cellulitis and DM be queried?

Lori.Drodge@mainehealth.org

I had the same question last year.  This is what a provider shared with me:  "cellulitis is not a complication of diabetes as is circulatory, neurological and nephrological disease.  Diabetes, uncontrolled, with persistent hyperglycemia >200 mmol/L, impairs chemotaxis of neutrophils thereby increasing the establishment of infection with bacterial exposure.  However, diabetes in and of itself does not cause cellulitis.  Cellulitis is inflammation of skin and subcutaneous tissues due to breakdown of skin with bacterial penetration.  Now, this is as opposed to diabetic dermatitis and necrobiosis lipoidica.  Just as sepsis is not a complication of diabetes, both sepsis and cellulitis have a higher probability to occur in an uncontrolled diabetic with virulence due to the issue with chemotaxis.  I would not assume the relationship, but certainly in the absence of any distinct cause (i.e. trauma, bite, etc.), I would query to establish if that relationship exists".