Health Information Management

Q&A: Linking/unlinking osteomyelitis with diabetes diagnosis

CDI Strategies, February 13, 2014

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Q: Please clarify the rule regarding presumption of the link of diabetes, when documented, to the diagnosis of osteomyelitis when both are documented by the provider. Does this rule of linking the diabetes to the osteomyelitis apply to only “acute” osteomyelitis, or does it apply to osteomyelitis regardless of whether it is documented as acute, chronic, or unspecified?
A: You are correct that there is an assumed relationship between diabetes and osteomyelitis when both conditions are present, unless the physician indicates the acute osteomyelitis is totally unrelated to the diabetes.
It does not matter if the osteomyelitis is acute, chronic, or unspecified. However, you would still want to further specify as much as possible the acuity as well as the location. I have always tried to teach physicians to clarify the level of acuity for any condition being treated. Osteomyelitis is a great example to use when teaching this point.
One other item to think of when reviewing records with osteomyelitis; there may be times, due to the “assumed” relationship, when you may need to query to unlink the two conditions. For example, if the record indicates a history of osteomyelitis and there is another possible cause of osteomyelitis, such as an infection due to a pressure ulcer or tuberculosis or typhoid. Another example might be if a patient has a complicated history including diabetes. In these instances, clarify with the physician the cause of the osteomyelitis. The fact that the osteomyelitis is not due to the diabetes would result in a different principal diagnosis.
Editor’s Note: Laurie L. Prescott, MSN, RN, CCDS, CDIP, is a CDI Education Specialist with HCPro Inc., in Danvers, Mass., and a lead instructor for its CDI-related Boot Camps. For more information regarding upcoming Boot Camp dates and locations visit This article was originally published on the ACDIS Blog.

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