Home Health ICD-9/ICD-10 Alert

Question: Our patient is receiving wound care for multiple pressure ulcers. He has a stage IV pressure ulcer on his sacrum, three stage I pressure ulcers on his upper back, and a stage III closed pressure ulcer on his ankle. The stage IV pressure ulcer was recently debrided.

-- Vermont Subscriber.

Answer: Code for this patient as follows, instructs Tricia A. Twombly, BSN, RN, HCS-D, CHCE senior education consultant and director of coding with Foundation Management Services in Denton, Texas:

• M1020a: 707.03 (Pressure ulcer; lower back)

• M1022b: 707.24 (Pressure ulcer stage IV )

• M1022c: 707.02 (Pressure ulcer; upper back)

• M1022d: 707.21 (Pressure ulcer stage I)

• M1022e: 707.06 (Pressure ulcer; ankle)

• M1022f: 707.23 (Pressure ulcer stage III).

Additional diagnoses:

• 728.87 (Muscle weakness [generalized])

• 788.30 (Urinary incontinence, unspecified)

• 787.6 (Incontinence of feces).

Your focus of care for this patient is wound care for his ulcers, so these diagnoses should be sequenced first. The stage IV pressure ulcer of the sacrum is the most serious, so list this first, followed by the stage I upper back pressure ulcers. Even though the stage III ankle pressure ulcer is closed, it's not considered healed, so you should continue to code for it.

For each pressure ulcer, you'll also need to list a 707.2x code to report the ulcer's stage. Although there are three pressure ulcers on this patient's lower back, you'll only list one code for all three of them. Remember, you cannot use the same code more than once and there is no way to code for bilateral ulcers in ICD-9.

Follow the pressure ulcer codes with the patient's additional diagnosis, which will also require skilled care. If the muscle weakness is more important than the stage I pressure ulcers, move muscle weakness into M1022e and move the other codes down.