Home Health ICD-9/ICD-10 Alert

Question: If a patient has multiple pressure ulcers such as stage IV to sacrum, buttock and right heel, stage III to ankle, and another stage II to the left heel, how do I sequence these so it is clear there are 2 heel ulcers, each with a different stage?

Answer: Code for this patient as follows:

M1020a: 707.03 (Pressure ulcer, sacrum);

M1020b: 707.05 (Pressure ulcer, buttock);

M1020c: 707.07 (Pressure ulcer, heel);

M1020d: 707.24 (Pressure ulcer, stage IV);

M1020e: 707.22 (Pressure ulcer, stage II);

M1020f: 707.06 (Pressure ulcer, ankle);

Other pertinent diagnoses: 707.23 (Pressure ulcer; stage III).

There really is no clear way to indicate the situation that you have described with ICD-9-CM and the official coding guidelines do not address how to code multiple pressure ulcers at different locations at the same stage.

The pressure ulcers at the sacrum, buttock and heel are all stage IV so you can code all the locations and then the stage. To be able to show that there is also a stage II ulcer to the other heel, add that code as well. However, there is no way to distinguish that the code for stage II only applies to the ulcer on the heel. Coding pressure ulcers will be much more straightforward when ICD-10 becomes effective.