Home Health ICD-9/ICD-10 Alert

Question: How do I code for a patient who has an ulcer on the back of his heel where his shoe rubs? The only diagnoses on the referral are diabetes and peripheral vascular disease (PVD). 

Maryland Subscriber

Answer: Not all ulcers in diabetic patients are diabetic ulcers. You can't assume that an ulcer on your diabetic patient's foot is a diabetic ulcer.

Diabetic ulcers of the foot generally start on the toes and move upward. Diabetic ulcers do not usually start on the heel.

Code for a diabetic ulcer on the heel with 250.8x (Diabetes with other specified manifestations) followed by 707.14 (Ulcer of foot, except decubitus). However, ulcers of the heel are almost always decubiti, coded with 707.07 (Decubitus ulcer; heel).

Peripheral vascular disease may include compromised arterial circulation, compromised venous circulation (stasis) or both. Ulcers can be the result of the lack of arterial circulation but are usually located on the toes or on the lateral side of the foot where circulation is not as good.

You can code for an arterial ulcer with 440.23 (Atherosclerosis of the extremities with ulceration) followed by 707.14.

Stasis ulcers are usually located on the inner aspect of the lower leg from the ankle to the knee. A stasis ulcer of the heel (without mention of varicosities) would be coded 459.81 (Venous [peripheral] insufficiency, unspecified) followed by 707.14.

You'll need to query the physician regarding the type of ulcer before you can select the right code for this patient.