ICD-10 Coding for Gangrene of Toe(E11.52, I70.26-, I96)
Complete ICD-10-CM coding and documentation guide for Gangrene of Toe. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gangrene of Toe
E11.5Primary Range
Type 2 diabetes mellitus with circulatory complications
Primary range for diabetic gangrene of the toe, includes gangrene as a complication.
Atherosclerosis of arteries of extremities
Used for gangrene due to atherosclerosis, not related to diabetes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | Use when gangrene is a complication of diabetes. |
|
| I70.26- | Atherosclerosis of native arteries of extremities with gangrene | Use when gangrene is due to atherosclerosis. |
|
| I96 | Gangrene, not elsewhere classified | Use when gangrene is unrelated to diabetes or atherosclerosis. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for gangrene of toe
Essential facts and insights about Gangrene of Toe
Primary ICD-10-CM Codes for gangrene of toe
Decision Criteria
clinical Criteria
- Presence of diabetes with gangrene
Applicable To
- Diabetic gangrene
Excludes
- Gangrene not due to diabetes (I96)
Clinical Validation Requirements
- HbA1c >6.5%
- Documented neuropathy or PAD
- Toe necrosis
Code-Specific Risks
- Incorrectly coding as I96 when diabetes is present.
Coding Notes
- Always sequence diabetes code first.
I70.26- - Atherosclerosis of native arteries of extremities with gangrene
Use when gangrene is due to atherosclerosis.
Applicable To
- Gangrene due to atherosclerosis
Excludes
- Diabetic gangrene (E11.52)
Clinical Validation Requirements
- ABI <0.5
- Imaging-confirmed arterial occlusion
Coding Notes
Ensure documentation of atherosclerosis.
I96 - Gangrene, not elsewhere classified
Use when gangrene is unrelated to diabetes or atherosclerosis.
Applicable To
- Gangrene not due to diabetes or atherosclerosis
Excludes
- Diabetic gangrene (E11.52)
- Atherosclerotic gangrene (I70.26-)
Clinical Validation Requirements
- Absence of diabetes or atherosclerosis
Coding Notes
Ensure no underlying diabetes or atherosclerosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Non-pressure chronic ulcer of foot
L97.5-Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gangrene of Toe to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E11.52.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential claim denials.
Mitigation Strategy
Educate providers on documentation requirements.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use E11.52 for diabetic gangrene.
Impact
Using I96 instead of E11.52 for diabetic gangrene.
Mitigation Strategy
Educate coders on correct code usage.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Gangrene of Toe, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gangrene of Toe
Use these documentation templates to ensure complete and accurate documentation for Gangrene of Toe. These templates include all required elements for proper coding and billing.
Diabetic gangrene of toe
Specialty: EndocrinologyRequired Elements
- Type of diabetes
- Gangrene location
- Presence of PAD or neuropathy
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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