# Skin opening due to edema



## codewrangler (Nov 19, 2014)

(Apologies in advance if this question's been addressed before. If so, I couldn't find it.)

I'm coding a chart where the patient has what's described by the clinician as an open wound on the ankle due to 4+ pitting edema. It's not clear how far down the tissue disruption extends.

Clearly, the open wound (870-899) codes aren't appropriate because they're for traumatic injuries, and the superficial injury (910-919) codes seem to focus on externally caused wounds as well. The best I could come up with is 707.13, Ulcer of ankle, but I'm not truly satisfied with that code either.

I would appreciate any guidance you can give me on this.

Thanks,
Victoria LeMere, CPC-A


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## ehanna (Nov 19, 2014)

I'm not sure I agree that the section for open wounds is strictly for traumatic injurys. I am looking at the section and not seeing anything that tells me these are only for traumatic injuries. The word traumatic is used a lot but not in all cases. I honestly feel it would be appropriate to use an open wound code. Please do respond and tell me if I have missed something in the ICD-9 and good luck. I will be interested to see what other people have to say on this case


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## codewrangler (Nov 19, 2014)

Thanks for weighing in, ehanna. 

I ruled out the open wound codes in Chapter 17 for 2 reasons (perhaps I was premature): 1. The Chapter 17 guidelines (section a) read at the end of the first paragraph "These *traumatic *injury codes are not to be used for . . . . ," and 2. In the index to diagnoses, the nonessential modifiers at the "Wound, open" top level all describe traumas: by cutting or piercing instrument, by firearm, etc.

The superficial injury codes also seem to point at external things (such as abrasion, insect bite, splinter) rather than disease/biological processes, like the edema due to CHF I'm looking at here.

I hope my reasoning makes sense. Like I said in the last post, I'm not really satisfied with the options I see. Let's hope there's something specific for this in ICD-10!


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## ntreber (Nov 21, 2014)

what about 459.81  with 707.13


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## codewrangler (Nov 24, 2014)

Thanks for the suggestion. I'm not sure about assigning 459.81, though. The record doesn't document any venous stasis or other peripheral insufficiency, just CHF with edema, HTN and cardiomyopathy. And edema, the reason behind the ulcer/wound, doesn't get coded because it's considered integral to the CHF. And that leaves me with the vague 707.13 . . .


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