Coding diabetes and gangrene

Coding diabetes with gangrene can be confusing. Here we will illustrate how to code by using three different scenarios. One thing we need to understand well before coding is that unlike all other conditions where the physician need to specifically relate correlation between diabetes and the condition, we can directly assume that gangrene and osteomyelitis are because of diabetes even if the physician has not documented the cause and effect relation. This rule applies unless there is a documentation that states that gangrene and osteomyelitis are not related to diabetes.

Here are some of the scenarios:
Gangrene and atherosclerosis of the extremities that is due to non insulin- dependent diabetes mellitus (NIDDM) : Assign code 250.70, Diabetes with peripheral vascular disorders as the principal diagnosis. Assign code 440.24, Atherosclerosis of extremities with gangrene, as an additional diagnosis. Do not assign code 785 .4, Gangrene, as this condition is included in the fifth digit for subcategory 440.2, Atherosclerosis of arteries of the extremities.

Coding Clinic March/April 1986, Volume 3, Number 2, Page 12 says
If no other "cause and effect" relationship has been established for the gangrene, assume that the gangrene is the consequence of a diabetic peripheral vascular circulatory disorder, 250.70, and add code 785.4 for gangrene. This is especially true when the gangrene is of the lower extremity. If there is a history of trauma, such as an open wound that became infected and progressed to gangrene, code it as open wound, complicated, and add code 785.4 for gangrene and 250.0 for diabetes.


Diabetic gangrene is 250.7x, 785.4.

Gangrene is not always the result of diabetes and can have different causes or no causes.

Diabetes with gangrene

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