Health Information Management

Coding for diabetic breast abscess

HIM-HIPAA Insider, December 1, 2009

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A: You cannot report ICD-9 code 250.90 (diabetes with unspecified complication) because the surgeon specified the abscess as the manifestation. Instead, report ICD-9 code 250.8x. I agree that ICD-9 code 611.0 (inflammatory disease of breast; abscess of breast) is the most accurate manifestation code. Your coding software may have rejected it because of a lack of a commonly accepted physiological connection between the diabetes and the breast abscess.
 
My first suggestion is to gather the research or evidence of this physiological connection. For example, consider looking at evidence-based medicine guidelines in The New England Journal of Medicine or other published research. If your claim is denied, submit this evidence with your appeal. This will provide justification to override the software rejection of the codes.
 
If you cannot find evidence, report diabetes code 250.0x (diabetes mellitus without mention of complication) along with code 611.0, and eliminate the connection between the diabetes mellitus and the breast abscess.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA,of Safian Communications Services in Orlando, FL, answered the previous question in the November issue of Briefings on Coding Compliance Strategies.



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