# Wagner Stage Ulcers



## Luna504

I need some help please.  At my office we have looked everywhere we can think of and can not find actual documentation from any site that states we are no longer using Wagner to code a diabetic ulcer.  From ICD training, if I am correct, we can use the stage but not code it as a diabetic ulcer unless the doctor says the words "diabetic ulcer."  If the doctor just states "Wagner Grade III" we cannot just code a diabetic foot ulcer stage III.  Is this correct and does anyone have a link they could provide so I can show this as correct coding guidelines?


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## mitchellde

Here is the textbook definition of the Wagner Ulcer Grade Classification system:
Wagner Ulcer Grade classification System Catergorizes dysvascular ulcers based on WOUND DEPTH and the presence of INFECTION.
Most commonly associated w/ assessment of DIABETIC FOOT ULCERS. Can appropriately be used to assiss must ulcers arising from NEUROPATHIC, ISCHEMIC, AND ARTERIAL etiology.

Since it says most commonly associated with diabetic foot ulcers and not exclusive to diabetic foot ulcers, you cannot assume the provider is referring to a diabetic ulceration.  It will need to be specifically documented.

As you can see this classification system can also be used with ulcers caused by other conditions.


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## Luna504

Thanks, that is very helpful.  Where did you get that definition?  I need something to print out and give to my director so we can forward it to the facilities and doctors.  I need something that is concrete and binding.  Can you guide me on that.  I have been looking on CMS and elsewhere.  I am new to coding, so I feel I might be missing some places to look.


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## mitchellde

I was in instructor in anatomy and physiology and this was from one of my Netters instructors books.


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## Luna504

Oh, great.  Thank you.


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## Fahad.Ogagang@MiraMedGS.com

*diabetic foot ulcer*

Coding Clinic, First Quarter ICD-10 2016 Page 12-13
States an Automatic Relationship
o    Diabetes and Foot Ulcer
o    Diabetes and Poluneuropathy
o    Diabetes and Chronic Kidney Disease

even if the provider does not indicate relationship of diabetes and ulcer according to the new coding clinic you can automatically code foot ulcer as diabetic foot ulcer


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## mitchellde

I would need to query coding clinic about that.  There has been nothing stated by the WHO that this has changed and that is a major change in logic.  Therefore I feel they would made that clear in the code set or in the official guidelines.  Until I get clear guidance I am staying with the logic that the relations must be documented.  
Also you need to take down the coding clinic attachment as that is a violation of the coding clinic copyright policy.  You can reference the issue and give in your own words a brief summary.


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## Fahad.Ogagang@MiraMedGS.com

*Ooppss*

thanks, Made a mistake there, already remove the attachment, just for education purpose only.


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## Luna504

Thanks for all the help.  Unfortunately at my work, the coding clinics for 2016 have no been updated yet.  And we have a lot of doctors that still want to just say Wagner Stage and not even say ulcer, foot, diabetic or anything.  It is very frustrating.


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