How would you code a patient with diabetes who presents with an abscess and osteomyelitis secondary to a puncture wound (injury vs a diabetic ulcer)?
In this case you will need to query the physician to determine if the osteomyelitis is due to the diabetes or is due only to the injury. Coding guidelines only assume a relationship between diabetes and osteomyelitis when no other stated cause of osteomyelitis is documented by the physician. In this case, if the physician indicates that the osteomyelitis is due to trauma, you are not required to code osteomyelitis as a complication/manifestation of diabetes, 250.8X & 731.8. Osteomyelitis in that case would be due to the puncture wound & abscess as a result of trauma. Osteomyelitis due to trauma may be a current injury or a late effect of a previous injury. Sequencing of osteomyelitis due to trauma is dependent on whether the patient was admitted to treat the open wound/abscess or the osteomyelitis. If the wound or abscess is trivial, or treated during an early episode, and focus of this admission is the osteomyelitis-the osteomyelitis can be sequenced as your principal diagnosis. The o
