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Orthopedic Coding Alert

New ICD-9 Codes Allow Site Specificity for Decubitus Ulcers

Published on Fri Jun 11, 2004

You have until Oct.1 to implement the new diagnosis code changes

Coders, take notice: At midnight on Sept. 30, you'll have to remove one set of decubitus ulcer ICD-9 codes and implement another.

The Centers for Disease Control and Prevention and CMS unveiled their new 2005 ICD-9 codes, and because payers do not allow a grace period for the new codes, you should update your superbills by Sept. 30.

Assign Decubitus Ulcer Codes Based on Site

Although the new ICD-9 codes aren't chock-full of orthopedic-specific changes, your practice may benefit from nine new decubitus ulcer codes.

"Decubitus ulcers include any chronic ulcer of the skin, including bedsores, plaster ulcers and pressure ulcers," says Mary J. Brown, CPC, CMA, coding specialist at OrthoWest PC, a seven-physician practice in Omaha, Neb. Foot and ankle specialists and orthopedic surgeons may use these codes for chronic or nonhealing skin ulcers that can occur from casts rubbing a patient's skin or prolonged periods of bed rest, Brown says.

"The code that you would use now is 707.0 (Decubitus ulcer), which is a generalized decubitus ulcer code," Brown says. "However, it appears that this code range (707.00-707.09, see below for definitions) will require a fifth digit to specify the location of the decubitus ulcer."

The new ulcer codes:

  • 707.00 - Decubitus ulcer, unspecified site
  • 707.01 - ... elbow
  • 707.02 - ... upper back
  • 707.03 - ... lower back
  • 707.04 - ... hip
  • 707.05 - ... buttock
  • 707.06 - ... ankle
  • 707.07 - ... heel
  • 707.09 - ... other site.

    'Unspecified' Differs From 'Other Site'

    Remember that "unspecified site" differs from "other site," says Anne Crandall, LPN, office manager at Spine and Sports PC in Memphis, Tenn.

    "You would bill out the unspecified code if the doctor didn't dictate the site and you had no information about it," Crandall says. "You would bill the 'other site'code if the doctor treated a site somewhere like the calf, which doesn't have its own code."

    Example: Suppose your orthopedist discovers decubi-tus ulcers on the left hip and buttock of a post-knee replacement patient. The orthopedist debrides partial-thickness skin on the hip and full-thickness skin on the buttock. He sends you the chart, and you contemplate the best way to show the insurer why you performed two types of debridement.

    Old way: Because previous ICD-9 editions listed only one decubitus ulcer code (707.0), you probably reported 11040 (Debridement; skin, partial thickness) and 11041 (... skin, full thickness) and linked both to 707.0.

    Practices often fought denials for these services because, without your orthopedist's operative report, insurers failed to understand why the physician performed two debridement procedures for one bedsore.

    New way: Coders will specify the separate bedsore sites to demonstrate medical necessity. You should report 11040 with 707.04 and 11041 with 707.05, starting Oct. 1.

    New DVT Codes Debut

    Also on the ICD-9 horizon are three new venous embolism codes. These better clarify deep venous thrombosis, which patients sometimes have after joint-replacement surgery. The following three codes are more specific than 453.8 (Other venous embolism and thrombosis; of other specified veins), which orthopedists previously used for this diagnosis:

  • 453.40 - Venous embolism and thrombosis of unspecified deep vessels of lower extremity
  • 453.41 - Venous embolism and thrombosis of deep vessels of proximal lower extremity
  • 453.42 - Venous embolism and thrombosis of deep vessels of distal lower extremity.

    To review a full listing of the new ICD-9 codes, visit the CMS Web site at www.cms.hhs.gov/medlearn/icd9code.asp#coding.

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