# Coding staged ulcers - Many medical records



## 05186111 (Dec 10, 2010)

Many medical records document ulcers with a stage, but never mention the words "pressure" or "decubitus".  For example, the final diagnostic statement may state "stage II ulcer right foot", or "stage III ulcer left buttock".  Can these types of statements be coded as pressure ulcers?


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## msrd_081002 (Dec 19, 2010)

*RE:Non-press chr ulcer & pressure ulcer coding*

It is *mandatory* to have the Physician documentation of “*pressure ulcer*” to assign codes from 707.0X with added stage ICD per CMS guideline
*Without further clarification from the physician, code 707.15 *If the physician documents skin ulcer but does not specify it as a decubitus ulcer, then assign code 707.1x with a fifth digit specifying the site of the skin ulcer.

Please read the rubric in specific-It reads Ulcer "except pressure ulcer" refrring to
ICDs' -707.10-707.19 + 707.8 reads "NON pressure ulcers" mentioned under each code.
Referring to your query:

Pressure ulcer & Decubitus ulcer get you to the *same ICD *707.0X Only. BUT Stages refer to *Pressure Ulcer ONLY*" (Please find the with authenticated CMS support documentation.) 
ICD-9-CM does *NOT classify "decubitus ulcer by stage". *Therefore, "anatomic site" code 707.0x is assigned for a stage 1 or 4 ulcer (AHA Coding Clinic for ICD-9-CM, 1999, fourth quarter, page 20).If a physician documents and treats a decubitus ulcer, then code 707.0x is assigned regardless of severity and stage. 

If pressure ulcer mentioned *by MD*, per CMS & National Pressure Ulcer Advisory Panel (NPUAP),
The pressure ulcer stage codes should only be reported as secondary diagnoses. As with all other secondary diagnosis codes, the pressure ulcer stage codes should be assigned only when they meet the definition of a reportable additional diagnosis (see section III, “Reporting Additional Diagnoses”).
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Non Pressure-Related Skin Ulcer/Wounds & Pressure ulcers 're *best explained in CMS MANUAL.*NOTE: 
1. http://www.hsag.com/App_Resources/Documents/PrU_LS1_F_314.pdf
2. Guidance regarding pressure ulcers is found at 42 CFR 483.25 (c), F314 Pressure Sore. PS:	http://www.ncdhhs.gov/dhsr/nhlcs/pdf/tag_314.pdf
3. Use F309 for issues of quality of care regarding non-pressure related ulcers PS	https://www.cms.gov/transmittals/downloads/R41SOMA.pdf
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From the information you've provided in the query post, you need to verify the "priors" to confirm Physicians ' mention of definitive dx of "pressure ulcer" if ANY, as it reads 'stages' ; Otherwise query physician.

Thanks


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