Guest post: Recent Coding Clinic provides guidance on diabetic peripheral angiopathy

CDI Blog - Volume 11, Issue 168

Lori Drodge,

By Lori Drodge, RHIT, CCS

Ever find yourself thinking that you have too much work to do to find time to read and digest a recent publication of AHA’s Coding Clinic? If so, your hospital’s severity adjusted data could be suffering. All conditions that meet reportable criteria should be correctly coded. Consider p. 7 of the most recent Coding Clinic:

“Peripheral arteriosclerosis, peripheral vascular disease and peripheral arterial disease in a diabetic patient should be linked and coded as ‘diabetic peripheral angiopathy.’"

If diabetes (E11.9) and peripheral artery disease (PAD) (I73.9) are coded separately for a patient who is admitted with pneumonia (J18.9), the severity of illness (SOI) and risk of mortality (ROM) assignments are 1/1.

Refer to the Alphabetic Index: Diabetes, with peripheral angiopathy is assigned E11.51. Remember the Official Guidelines for Coding and Reporting state that the term “with:”

“presumes that conditions are related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions.”

When these two conditions are coded together as E11.51 (diabetic peripheral angiopathy) the SOI increases to 2.

A true reflection of the SOI/ROM of your patients is important to capture the complexity of medical decision-making. Diabetic patients who have manifestations of their disease should not be insufficiently represented by an “uncomplicated” diabetes status.

This reflects the importance of:

  • Assigning all reportable codes correctly, regardless of the absence of DRG impact
  • Keeping up to date with coding instruction

This can be challenging but the benefits are clear.

Editor’s Note: Drodge is the DRG Coordinator and CDI Liaison for an acute care hospital in Maine, Approved ICD-10-CM Trainer and Co-Chair of the ACDIS Regulatory Committee.

Found in Categories: 
ACDIS Guidance, Clinical & Coding