# Coding a diabetic ulcer



## donnagullikson (Sep 8, 2016)

Patient has a plantar foot Wagner Grade 3 Diabetic ulcer.  I know I code E11.621 first and then list the non-pressure ulcer L97.____  but what is a wagner grade 3 diabetic ulcer equivalent to: 1) bone necrosis 2) exposed fat layer 3) muscle necrosis or 4) skin breakdown only?

These confuse me because I thought Wagner Grade 3 were used for pressure ulcers.

Thanks for your help.


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## stephanie.moore@wdhospital.com (Sep 8, 2016)

The Wagner-Meggitt classification7 is based mainly on wound depth and consists of 6 wound grades. These include: grade 0 (intact skin), grade 1 (superficial ulcer), grade 2 (deep ulcer to tendon, bone, or joint), grade 3 (deep ulcer with abscess or osteomyelitis), grade 4 (forefoot gangrene), and grade 5 (whole foot gangrene).


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## donnagullikson (Sep 8, 2016)

*Coding diabetic ulcer*

So, other than E11.621 what other diagnosis L97 would I use?

Thanks,


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## stephanie.moore@wdhospital.com (Sep 8, 2016)

If what you shared is the documentation in its entirety I would query the provider. You do not have LATERALITY or the SPECIFICITY of the ulcer        without that it codes to L97.409. I have attached a cheat sheet that I gave my providers with the transition of 9 to 10 if you would like to share it with your providers. 

Kind Regards,


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## donnagullikson (Sep 8, 2016)

*Coding diabetic ulcer*

So, to know what L97. code to use I need to know what to look for when deciding if it's breakdown of tissue, bone necrosis, muscle necrosis or exposed fat layer.  Can someone give me some key words to look for in the report so I can accurately code these reports. The physicians do document a lot in their report but I just need a little help.  The physicians do give me the debridement codes 11042, 11045, 11043, 11046, 11044 or 11047.  So, I guess I could say all 11042's are for breakdown of skin (Sub-q tissue, which includes the epidermis and dermis) all 11044 are for muscle/fascia etc...

Thanks,


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