Co-morbidity factoring for MDM

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Posts: 45
Joined: Sat Dec 20, 2014 9:32 pm

Tue Sep 19, 2017 4:22 pm

Hello! Thank you in advance for your help.

We have a patient who is being treated for a pressure ulcer which she has had since June (approximately 4 months). In addition, she is diabetic.

The question is in counting the correct number of diagnosis or treatment options for this patient. The provider of the note in question is a trauma provider.

The wound is worsening, and 2 points were awarded.

The provider also stated in the HPI portion of the note that the patient's A1C was improving and noted that "Her sugars are down on a positive note".

This provider is not treating the DM, but it definitely is a co-morbidity that could affect what she is treating. One coder thinks that an additional point for the stable/improved problem should be given for the DM, another does not. This scenario has been ran past another outside auditor who agrees that it should be counted as one point in addition to the worsening problem. Could someone please share guidance on this?

Thank you again.

J Jones
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Posts: 474
Joined: Mon Apr 09, 2012 1:54 pm

Mon Sep 25, 2017 11:45 am


I would agree that both conditions can be counted towards the diagnosis points. The first listed code should be diabetes with a complication of foot ulcer or skin ulcer E11.62- then a secondary diagnosis is required to specify the ulcer itself by wound location L97.-. Because the patient has an ulcer with diabetes the provider does have to take that into account when they are assessing, monitoring and treating the patient for the ulcer.

Thank you, CPC, CEMA, RHIT
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