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General Surgery Coding Alert

New Diagnoses for Decubitus Ulcers Should Help Reduce Denials

Published on Thu Jun 24, 2004

Site-specific ICD-9 codes will increase your options when describing multiple ulcers

General surgery coders, take note: You'll no longer have to rely on a single diagnosis code for decubitus ulcers in multiple locations. For 2005, ICD-9 will include nine site-specific codes to describe ulcers by anatomic location.

The Centers for Disease Control and CMS have unveiled their new 2005 ICD-9 codes, and because payers do not allow a grace period for the new codes, you should ensure that your superbills are updated by Sept. 30, 2004.

Assign Decubitus Ulcer Codes Based on Site

Of the new ICD-9 codes for 2005, general surgery practices are most likely to benefit from nine new decubitus ulcer diagnoses, which will allow surgeons to pinpoint the location of the ulcers with greater specificity.

"Decubitus ulcers include any chronic ulcer of the skin, including bedsores, plaster ulcers and pressure ulcers," says Mary J. Brown, CPC, CMA, coding specialist for a seven-physician practice in Omaha, Neb.

"The code that you would use now to describe such an ulcer is 707.0 (Decubitus ulcer), which is a 'generalized'decubitus ulcer code," Brown says. "However, it appears that this code range [707.00-707.09, see below for definitions] will now require a fifth digit to specify the location of the decubitus ulcer."

The new bedsore codes include:

  • 707.00 -- Decubitus ulcer, unspecified site
  • 707.01 -- ...elbow
  • 707.02 -- ... upper back
  • 707.03 -- ... lower back
  • 707.04 -- ...hip
  • 707.05 -- ... buttock
  • 707.06 -- ...ankle
  • 707.07 -- ...heel
  • 707.09 -- ... other site.

    Remember that "unspecified site" differs from "other site," says Anne Crandall, LPN, office manager at Spine and Sports PC in Memphis, Tenn. "You would bill the unspecified code if the doctor didn't dictate the site and you had no information about it," Crandall says. "You would bill the 'other site'code if the doctor treated a site somewhere like the calf, which doesn't have its own code."

    Example: Suppose your surgeon discovers decubitus ulcers on the patient's left hip and buttock. The surgeon debrides partial-thickness skin on the hip and full-thickness skin on the buttock. He sends you the chart, and you contemplate the best way to show the insurer why you performed two types of debridement.

    Old way: Because previous ICD-9 editions listed only one decubitus ulcer code (707.0), you probably reported 11040 (Debridement; skin, partial thickness) and 11041 (... skin, full thickness) and linked both to 707.0. Practices often fought denials for these services because, without your surgeon's operative report, insurers failed to understand why the physician performed two debridement procedures for one bedsore.

    New way: Coders can now specify the separate bedsore sites to demonstrate medical necessity. You should report 11040 with 707.04 (to identify the location as the hip) and 11041 with 707.05 (to identify the location as the buttock).

    Look for New Embolism/Thrombosis Codes, Also

    For 2005, you'll also be able to access three new codes to describe lower-limb venous embolism and thrombosis:

  • 453.40 -- Venous embolism and thrombosis of unspecified deep vessels of lower extremity
  • 453.41 -- Venous embolism and thrombosis of deep vessels of proximal lower extremity
  • 453.42 -- Venous embolism and thrombosis of deep vessels of distal lower extremity.

    With these codes, you may select a more precise diagnosis for venous embolism and thrombosis of the lower limbs, whereas previously you could only select the "unspecified" code 453.9 (Other venous embolism and thrombosis of unspecified site).

    Tip: To review a full listing of the new ICD-9 codes, visit the CMS Web site at www.cms.hhs.gov/medlearn/icd9code.asp#coding.

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