Coding All-Stars, Step Right Up!

This week, Julia Palmer, Project Manager with the Consulting Services Business Unit of 3M HIS joins HIMagine That’s Sue Belley to introduce the 3M Coding Challenge.

Things are really kicking into high gear in the world of healthcare information management. Inpatient and outpatient coders, CDI specialists, and professional staff are ramping up their preparations for the ICD-10 transition by doing everything from engaging ICD-10 through dual coding to measuring the financial and productivity impact of ICD-10.

In response to this, 3M is launching an ICD-10 coding challenge. We will post ICD-10 scenarios each month. Those entering correct answers will be entered in a drawing for prizes. Then we’ll report back each month and talk about what we’ve learned from the response. This is a chance for you to dig in, roll up your sleeves, and test your skill at solving ICD-10 scenarios.  Take a look below for an idea of what the scenarios, answers, and commentary will look like.


Assign ICD-10 diagnosis codes for the following scenario.  The code listed first should be the reason for encounter as required by coding guidelines.


A Type 1 diabetic patient was seen in the outpatient clinic for aftercare following surgery ten days ago for a below knee amputation of the left leg for a non-healing gangrenous ulcer on his left foot secondary to diabetic peripheral angiopathy. The physician documented the operative site was healing very nicely, and there was no evidence of infection.  Physician’s diagnoses: status post below knee amputation, diabetes mellitus with peripheral angiopathy.


Z47.81             Encounter for orthopedic aftercare following surgical amputation

Z89.512           Acquired absence of left leg below knee

E10.51             Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene

Blog Commentary

As you may know by now, some things will change and some things will remain the same in the ICD-10 world.  We know the codes have changed – they look different due to the fact that they are all alphanumeric and there are more digits.  That aside, for this scenario, what remains the same is the coding guideline for listing first the reason for the encounter, orthopedic aftercare following surgical amputation, Z47.81, for the below the knee amputation.  Z89.512 is assigned additionally to show the absence of the leg below the knee, specifically the left leg.  That’s a change since we couldn’t designate laterality of an amputation in ICD-9.  Finally, E10.51, a combination code, is assigned for Type 1 diabetes with diabetic peripheral angiopathy without gangrene.  That’s another change because one code covers it all in ICD-10 (it took two or more codes in ICD-9). The ICD-10 diabetes code includes the type of diabetes mellitus, the body system affected, and the complication affecting that body system.

The 3M Coding Challenge kicks off Monday, June 17. Get ready!

Sue Belley is a Project Manager and Senior Consultant with the Consulting Services business of 3M Health Information Systems.

Julia Palmer is a Project Manager with the Consulting Services business of 3M Health Information Systems.

3 responses to “Coding All-Stars, Step Right Up!

  1. I would also add a code of Z86.31 for personal history of diabetic foot ulcer

    • Sue Belley and Donna Smith

      (Comment by Julia Palmer and Sue Belley) We agree it is acceptable to add this history code. According to ICD-10-CM Official Guidelines for Coding and Reporting, history codes are acceptable on any medical record regardless of the reason for visit.

  2. Clinical advice confirmed that amputee status of the lower limb, regardless of what caused the amputation, contributes to the criteria for diabetic foot as specified in ACS 0401, 6. Diabetic foot, Category 2d. This is because prior amputation presents increased risk of contralateral foot lesion (eg ulcer) and other complications (eg excessive loading) associated with diabetic foot–E1 . 73 should be code

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