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Watch for New Pressure Ulcer Options in ICD-10

Published on Thu Apr 17, 2014

Question: My patient has two pressure ulcers in separate locations (left hip and left buttock) and both ulcers are stage II. My software will not allow me to enter the stage code twice, but according to coding conventions, I need to enter the stage code immediately after the location code. How do I handle this? Is there any difference in guidelines if I have two pressure ulcers in the same location, but they are at different stages?

Florida Subscriber

Answer: Many software packages have this issue, says Jan McLain, RN, BS, LNC, HCS-D, COS-C, BCHH-C, medical review resource nurse specialist with Altamonte Springs, Fla.-based Adventist Health System.
 
To code the first scenario you describe, list the following codes:
  • 707.04 (Pressure ulcer; hip);
  • 707.05 (Pressure ulcer, buttock); and 
  • 707.22 (Pressure ulcer stage II).
If your patient has two pressure ulcers on the buttock (707.05), one stage III and the other is a stage II. You would list the location first followed by the stage. Your coding would look like this:
  • 707.05;
  • 707.23 (Pressure ulcer stage III); and
  • 707.22. 
You cannot repeat the codes to indicate there is more than one pressure ulcer in the same location. 
In ICD-10 coding, not only are the stage and location of the pressure ulcer combined into one code, but you’ll also be able to indicate the side affected. The codes for pressure ulcers are one of the great improvements you’ll find as you make the transition to ICD-10, McLain says. With the greater specificity of the codes in ICD-10, you can report the specific site and stage of the ulcer succinctly and completely using just one code.
 
So, in ICD-10, for the first scenario, you would report:
  • L89.222 (Pressure ulcer of left hip, stage 2) and
  • L89.322 (Pressure ulcer of left buttock, stage 2).
And, to code for two stage III pressure ulcers on the buttocks, one on each side, in ICD-10, you would report L89.313 (Pressure ulcer of right buttock, stage 3) for the right side, and L89.323 (Pressure ulcer of left buttock, stage 3) for the left side.
 
For the second scenario you ask about, in which there are two pressure ulcers on the right buttock — one a stage III and one a stage II, you would report
  • L89.313 and 
  • L89.312 (Pressure ulcer right buttock, stage 2). 

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