diabetic gangrene

Padawan5773

Hi everyone,

I was wondering if anybody else came across this.  So we have a patient that has diabetes and PVD and as a result has diabetic gangrene.  I've asked this question to our auditor and our coders and other CDI staff.  My understanding was you could not get credit twice for the same condition reported. 

Going through the codebook, when you look up gangrene associated with diabetes, it directs you to the E11.52 code.  We have been told in our audits that we can use I96 as a secondary which made no sense to me because the gangrene was specified as associated with diabetes, why use an unspecified code for the same condition?  There is no nosology edit or Excludes Note that says you absolutely cannot code both.  It added a CC to cases that did not have a CC, but to me this sounds unethical, like you were trying to get double credit for treating the same condition... any thoughts?

Christopher

BTC2018

Since E11.52 is a 'combo' code that specifies 'with gangrene', do not code I96 when it represents DM with gangrene w/PVD. See the instructions for 'Combination Code' (OCG I.B.9), code E11.52 identifies all of the elements documented in the diagnostic statement. 

sherisimoni@comcast.net

There is a Coding Clinic 4Q 2017, pg. 102 that addresses this issue. When a patient has gas gangrene with diabetic PVD an additional code for gas gangrene A48.0 is assigned because it describes the type of gangrene and provides detail about the patient's condition. If the gangrene is not gas and other/unspecified then I96 Gangrene, not elsewhere classified is assigned. It is appropriate to assign the additional code for the specific type of gangrene as the combo code doesn't provide this level of specificity.