Question: I'm confused about how to code for a stasis ulcer. How should my coding differ if the patient has a varicose vein? What if the patient doesn't have a varicose vein? I want to make sure I am accurately describing the wound care we will provide. How does the coding impact the answers in M0468-476? North Carolina Subscriber
Answer: There are actually many related conditions that may cause a stasis ulcer. As long as the ulcer results from stasis of the blood flow, then you should answer M0468-M0476 the same for each kind of stasis ulcer. For a stasis ulcer associated with a varicose vein report either 454.0 (Varicose veins of lower extremities; with ulcer) or 454.2 (Varicose veins of lower extremities; with ulcer and inflammation).
If you aren't provided these details or any other information regarding the stasis ulcer, then you should code 459.81 (Venous [peripheral] insufficiency, unspecified) followed by the appropriate 707.1x (Ulcer of lower limbs, except decubitus) code. This is the big difference between category 454.x and 459.81 -- 459.81 requires a second code to indicate the ulcer whereas 454 does not.