Gastroenterology Coding Alert

Question: I'm looking for the right ICD-9 code that specifically describes pressure ulcer. Could you help?

Illinois Subscriber

Answer: In 2009, ICD-9 unveiled a new code set for pressure ulcer. Where, in the past, you used 707.0x (Decubitus ulcer) for the condition, now you can code the ulcers by stage.

Here's a rundown of the new codes, as well as some clinical descriptions of the associated condition:

• 707.20 (Pressure ulcer, unspecified stage) -- Use this code if the internist has not specified the stage of the injury.
• 707.21 (Pressure ulcer, stage I) -- "Intact skin with non-blanchable redness of a localized area usually over a bony prominence" marks a stage I ulcer, according to a National Pressure Ulcer Advisory Panel (NPUAP) 2007 release.
• 707.22 (Pressure ulcer, stage II) -- Stage II patients may present with an intact or open/ruptured serumfilled blister. Other characteristics of these ulcers are "partial- thickness loss of dermis presenting as a shallow, open ulcer with a red/pink wound bed,

without slough," the NPUAP reports.

• 707.23 (Pressure ulcer, stage III) -- Stage III ulcer sufferers will have full-thickness tissue loss; there may be subcutaneous fat visible at the injury site, but there is no exposure of bone, tendon or muscle. The internist may use undermining or tunneling on stage III ulcer patients.
• 707.24 (Pressure ulcer, stage IV) -- Patients with stage IV ulcers will have full-thickness tissue loss with some exposed bone, tendon or muscle. The internist very often selects undermining or tunneling for these patients, NPUAP says.

Background: According to NPUAP, a pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.