AHA Coding Clinic® for ICD-9 - 2004 Issue 3; Ask the Editor

Cellulitis and Stasis Dermatitis

An 89-year old man presented to the hospital with swollen legs, cellulitis, draining ulcers and crusting. The patient had a previous leg injury resulting in cellulitis that required hospitalization. The dermatology consultant diagnosed stasis dermatitis, grading into elephantiasis nostra and stasis ulcerations and cellulitis. The alphabetic index leads to code 454.2, Varicose veins of lower extremities; however Coding Clinic Second Quarter 1991, page 20, states: “if neither varicose veins or past deep vein thrombosis is involved, the code assignment would be 459.81, Venous (peripheral) insufficiency, unspecified. The basic rule of coding is that further research is done if the title of the code suggested by the index clearly does not identify the condition correctly. In this case, even though the index takes you to a code involving varicose veins, the code cannot be used when no varicosities are present.” Is this advice still valid and what is the principal diagnosis for this case? ...

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