Internal Medicine Coding Alert

Your coding options explode with ICD-10.

Recent statistics show that up to 25 percent of women and 18 percent of men will suffer from varicose veins in their lifetime. In a related condition, 60 percent of leg ulcers are due to varicose veins.

When the internist diagnoses varicose veins with ulcers, under ICD-9 you report 454.0 (Varicose veins of lower extremities with ulcer). Once ICD-10 is implemented, you'll need to pay closer attention to the documentation, because your code choices will be based on more exact anatomic sites. Those options include:

• I83.009 -- Varicose veins of unspecified lower extremity with ulcer of unspecified site
• I83.019 -- Varicose veins of right lower extremity with ulcer of unspecified site
• I83.029 -- Varicose veins of left lower extremity with ulcer of unspecified site.

Explanation: In essence, the fifth character will indicate which extremity (if specified) is involved, and the sixth character will specify the site of the ulcer on that extremity. Also, you will need to use a code from the L97.- series to identify the severity of the ulcer. For instance, if the ulcer is on the right thigh and limited to breakdown of the skin, you would report L97.111 (Non-pressure chronic ulcer of right thigh limited to breakdown of skin) as a secondary diagnosis.

Other details: The correct diagnosis might change, depending on how many details your provider includes in her documentation. For example, if she specifies varicose veins in the left leg with ulcer and inflammation, you'll choose I83.229 (Varicose veins of left lower extremity with both ulcer of unspecified site and inflammation).