General Surgery Coding Alert

Question: If the surgical note documents Wagner’s ulcer classification for a debridement procedure, is there a way to correlate that with ICD-9 and CPT® codes to bill for the service?

Texas Subscriber

Answer: Although Wagner’s ulcer classification might give some hints for the CPT® code, it won’t impact your ICD-9 choice.

Diagnosis: Wagner’s method classifies ulcers according to their depth and other characteristics, as follows:

• 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.

On the other hand, ICD-9 classifies ulcers according to their type, decubitus (707.0x) or non-decubitus (707.1x), and their location (ankle, heel, midfoot). That means the Wagner’s classification doesn’t help you choose an ICD-9 code.

Procedure: Because the CPT® code you select is based partially on the depth to which the surgeon debrides the wound, the Wagner’s classification may be helpful.

For instance, debridement for a grade 3 ulcer might correlate to 11044 (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq cm or less) rather than 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq. cm or less).

Key: Regardless of the Wagner’s classification, it’s the surgeon’s description of his work that should determine your CPT® code choice, 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 surgeons can say an ulcer is Wagner’s Grade 3 and yet the wounds may be nothing alike.