Dermatology Coding Alert

Question: Is there a method of correlating Wagner’s ulcer classification to ICD-9 and CPT^® codes? For example, how should one report a grade 3 ulcer?

Louisiana Subscriber

Answer:  You really don’t need to worry about Wagner’s ulcer classifications when you’re trying to determine a diagnosis code from the dermatologist’s chart notes. Wagner’s method classifies ulcers according to their depth, while ICD-9 classifies ulcers according to their type, decubitus (707.0x) or non-decubitus (707.1x), and their location (ankle, heel, midfoot).

Wagner’s ulcer classification: Grade 0: No open ulceration; Grade 1: Full thickness ulcer, not beyond loss of skin; Grade 2: Deep ulceration with exposed tendon/joint; Grade 3: Ulcer extends down to bone, osteomyelitis may be present; Grade 4: Wet or dry gangrene may be present; Grade 5: Extensive gangrene with no local salvageable procedure

Besides the diagnosis differences, the CPT^® code you select is based on the depth to which the podiatrist debrides the wound, not the initial depth of the wound itself. While Wagner’s scale does provide medical information on the ulcer, it is not information relevant to coding. The scale is also seen as highly subjective; two podiatrists can say an ulcer is Wagner’s Grade 3 and yet the wounds may be nothing alike.