A 79-year-old male with type 2 diabetes mellitus presented due to acute cellulitis of the left lower leg. The patient was admitted and started on broad-spectrum antibiotics. When assigning the diabetes code, would it be appropriate to report the code for diabetes “with skin complication NEC?” What is the appropriate code assignment for cellulitis in a patient with type 2 diabetes?
In order to link the diabetes and the cellulitis, the provider would need to document cellulitis as a diabetic skin complication. When the causal relationship is unclear, query the provider regarding the linkage and whether cellulitis is a skin complication caused by the diabetes. Each case is patient specific, and the relationship between diabetes and cellulitis should be clearly documented by the provider. When the coder is unable to determine whether a condition is a diabetic complication, or the ICD-10-CM classification does not provide instruction, it is appropriate to query the physician for clarification so that the appropriate codes may be reported.“Diabetes with skin complication NEC,” is indexed, but “diabetes with cellulitis” is not specifically indexed. The “with” guideline does not apply to “not elsewhere classified (NEC)” index entries that cover broad categories of conditions. Specific conditions must be linked by the terms “with,” “due to” or “associated with”. Coding professionals should not assume a causal relationship when the diabetic complication is “NEC.” The ICD-10-CM classification presumes a cause and effect relationship with certain specific conditions when the Alphabetic Index links the conditions by the terms “with”, “due to” or “associated with”.